New 3-drug treatment for relapsed multiple myeloma

Volume 4, Issue 1, 2015

Summary

Drug combo provides unprecedented benefits, including longer remission.

Photograph of Keith K. Stewart, M.B., Ch.B.

Keith K. Stewart, M.B., Ch.B.

In the treatment of relapsed multiple myeloma, the addition of carfilzomib to a currently accepted two-drug combination produced significantly better results than using the two drugs alone, according to a worldwide research team led by investigators from the Mayo Clinic Cancer Center.

The multiple myeloma treatment findings were published in the New England Journal of Medicine and presented at the 56th annual meeting of the American Society of Hematology.

Interim analysis of the phase III clinical trial known as ASPIRE, which enrolled 792 patients with relapsed multiple myeloma from 20 countries, found an unprecedented prolongation of the time patients were free of disease progression when using the three-drug combination, said the study's lead investigator, Keith K. Stewart, M.B., Ch.B., a Mayo Clinic Cancer Center oncologist in Arizona.

"Patients taking three drugs — carfilzomib, lenalidomide and dexamethasone — stayed free of disease progression for 26 months on average," he said. "No one has reported anything like this before for relapsed multiple myeloma."

Researchers found that adding carfilzomib to standard treatment with lenalidomide and dexamethasone resulted in an additional 8.7 months of remission, bringing it to 26.3 months — almost 50 percent longer than the 17.6 months of remission under the standard two-drug combination.

The number of patients who responded to treatment was also significantly improved by adding carfilzomib to standard treatment — 87.4 percent vs. 66.9 percent. And the number of patients who had no detectable disease after the three-drug treatment more than tripled, 31.8 percent vs. 9.3 percent.

Although results were preliminary, the study also showed a trend toward improved overall survival. Patients on the three-drug cocktail also reported a better quality of life despite a higher intensity of treatment.

"These findings highlight increasing success in treating myeloma, the second most common blood cancer," Dr. Stewart said. "Survival of multiple myeloma has almost doubled over the last decade, and the very positive outcomes from use of the three-drug combination will likely further improve outcomes."

The Mayo Clinic Cancer Center is a leader in carfilzomib clinical research. Because of their expertise in basic and clinical research and treatment for multiple myeloma, Cancer Center investigators were asked to conduct a phase I study of carfilzomib by its developers.

"We were among the first centers in the world to use this drug and the first to have a patient who responded to it, back in 2006," Dr. Stewart noted.

The Mayo Clinic Cancer Center researchers also participated in phase II studies of carfilzomib and then were asked to lead the definitive phase III ASPIRE clinical trial.

"We hope the results of this trial will lead to approval of this treatment combination in patients with relapsed multiple myeloma worldwide," Dr. Stewart said.