Weekly IMiD-Free Regimen for Relapsed/Refractory Multiple Myeloma

A study published in the American Journal of Hematology evaluated the safety and benefit of weekly infusion of an immunomodulatory drug (IMiD)-free carfilzomib-based regimen for patients with relapsed/refractory multiple myeloma (RRMM).

The study reported updated results a phase II trial of carfilzomib, cyclophosphamide, plus dexamethasone (KCd), “a convenient IMiD‐free regimen,” wrote the authors. Seventy-six patients with RRMM were enrolled. Patients received once-weekly carfilzomib 20/70 mg/m2, cyclophosphamide 300mg/m2, and dexamethasone 40 mg for a 28-week cycle. The primary endpoint was the overall response rate (ORR) after four cycles. Secondary endpoints included toxicity, response depth, and progression-free (PFS) and overall survival (OS).

The ORR for the entire cohort was 85%, with 68% of patients achieving at least a very good partial response (VGPR) and 29% achieving a complete response (CR). The median OS was 27 months and the median PFS was 17 months.

Patients with high-risk MM showed less benefit from the treatment compared to non-high-risk patients (ORR 75% vs. 97%; P = 0.013). The median OS of high-risk patients was 18 months, but was not yet met for those without high-risk cytogenetics. Median PFS was also lower for the high-risk group compared with the regular-risk group, or 14 months versus 22 months, respectively (P = 0.06). The most common non-hematologic grade ≥3 adverse events were infection, vascular events, and cardiac events.

In conclusion the authors wrote, “The [weekly] KCD is a safe and effective regimen in relapse, especially for patients ineligible for lenalidomide‐based therapies.”