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The ENDEAVOR phase III trial compared the efficacy of carfilzomib and dexamethasone (Kd) plus bortezomib and dexamethasone (Vd) in relapsed and refractory Multiple Myeloma (MM) patients, and showed a significant benefit in progression free survival (PFS) for the use of Kd. A subset of MM patients has a high-risk cytogenetic status, based on the presence of the following genetic abnormalities: translocations: t(4;14) or t(14;16), and the deletion: del(17p). In a pre-planned sub-group analysis, the PFS benefit of Kd versus Vd was assessed for high-risk cytogenetic status versus standard risk status, and the findings published in Leukemia in June 2017, by W-J. Chng and colleagues from the National University Cancer Institute, Singapore. For details of the clinical trial set-up, see previous MM Hub article.
In conclusion, the PFS benefit and superiority of carfilzomib and dexamethasone compared to bortezomib and dexamethasone, carries through into MM patients with high-risk genetic abnormalities, regardless of the number and type of prior treatment regimens. This finding is consistent with the sub-group analysis of the ASPIRE clinical trial, which assessed carfilzomib in combination with lenalidomide and dexamethasone, suggesting that the addition of carfilzomib offers a distinct advantage for patients with high-risk MM.
The randomized phase 3 study ENDEAVOR demonstrated a statistically significant and clinically meaningful improvement in progression-free survival (PFS) for carfilzomib and dexamethasone (Kd) vs bortezomib and dexamethasone (Vd) in relapsed or refractory multiple myeloma(MM). We conducted a preplanned subgroup analysis of ENDEAVOR to evaluate Kd vs Vd by cytogenetic risk. Of 785 patients with known cytogenetics, 210 (27%) had high-risk cytogenetics (Kd, n=97 (25%); Vd, n=113 (28%)) and 575 (73%) had standard-risk cytogenetics (Kd, n=284 (75%); Vd, n=291 (72%)). Median PFS in the high-risk group was 8.8 months for Kd vs 6.0 months for Vd (hazard ratio (HR), 0.65; 95% confidence interval (CI), 0.45-0.92; P=0.0075). Median PFS in the standard-risk group was not estimable for Kd vs 10.2 months for Vd (HR, 0.44; 95% CI, 0.33-0.58; P<0.0001). Overall response rates were 72.2% (Kd) vs 58.4% (Vd) in the high-risk group and 79.2% (Kd) vs 66.0% (Vd) in the standard-risk group. In the high-risk group, 15.5% (Kd) vs 4.4% (Vd) achieved a complete response (CR) or better. In the standard-risk group, 13.0% (Kd) vs 7.9% (Vd) achieved ⩾CR. This preplanned subgroup analysis found that Kd was superior to Vd in relapsed or refractory MM, regardless of cytogenetic risk.
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