|The following article features coverage from the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting. Click here to read more of Hematology Advisor‘s conference coverage.|
Among patients with multiple myeloma (MM) with at least 1 high-risk cytogenetic abnormality, a carfilzomib (K)-based induction or consolidation regimen, with or without autologous transplant (ASCT) and followed by lenalidomide (R) or KR maintenance, may yield strong progression-free survival (PFS) rates, according to research presented at the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting.
Patients with MM with cytogenetic abnormalities represent a population with unmet clinical needs and for whom novel therapy regimens are badly needed. Previous results from the randomized FORTE trial (ClinicalTrials.gov Identifier: NCT02203643) suggested that a KR-dexamethasone (KRd) induction or consolidation regimen with ASCT (KRd_ASCT) may yield improved PFS outcomes compared with no ASCT and with other therapeutic combinations.
For this part of FORTE, researchers evaluated the comparative safety and efficacy of KRd_ASCT with K, cyclophosphamide, and d (KCd) with ASCT (KCd_ASCT) and with KRd without ASCT (KRd12), all followed by KR or R maintenance therapy, among patients with cytogenetic abnormalities and those without, who were considered standard-risk (SR). Patients with cytogenetic abnormalities, including del17p, t(4;14), t(14;16), del1p, and 1q gain (3 copies) or amp1q (at least 4 copies), were classified as either single-high-risk or greater (HiR) or double-hit or greater high-risk (DH).
Of the 474 patients enrolled, 396 were included in this analysis; 243 were HiR, 105 were DH, and 153 were SR. Patients with SR disease has 4-year PFS rates of 80% with KRd_ASCT, 67% with KRd12, and 57% with KCd_ASCT.
Among patients in the HiR group, KRd_ASCT yielded improved PFS rates vs KRd12 (hazard ratio [HR], 0.6; P =.04) and vs KCd_ASCT (HR, 0.57; P =.01); these corresponded to 4-year PFS rates of 62%, 45%, and 45%, respectively.
Among patients in the SR group, KR improved 3-year PFS rates vs R numerically, but not significantly (90% vs 73%, respectively; HR, 0.42; P =.06), though this finding was significant among patients in the HiR group (69% vs 56%, respectively; HR, 0.6; P =.04).
Patients with amp1q had the worst outcomes regardless of treatment assignment.
Data on overall survival are not yet mature, according to the study’s presenter.
Disclosure: The study author(s) declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Read more of Hematology Advisor’s coverage of the 2021 ASCO Annual Meeting by visiting the conference page.
Gay F, Mina R, Rota-Scalabriniet D, al. Carfilzomib-based induction/consolidation with or without autologous transplant (ASCT) followed by lenalidomide (R) or carfilzomib-lenalidomide (KR) maintenance: efficacy in high-risk patients. J Clin Oncol. 2021;39:(suppl 15; abstr 8002). doi:10.1200/JCO.2021.39.15_suppl.8002