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Puertas B, González-Calle V, Sureda A, Moreno MJ, Oriol A, González E, Rosiñol L, López J, Escalante F, Martínez-Lopez J, Carrillo E, Clavero E, Ríos-Tamayo R, Rey-Bua B, González-Rodríguez AP, Dourdil V, de Arriba F, González S, Pérez-de-Oteyza J, Hernández MT, García-Mateo A, Bargay J, Bladé J, Lahuerta JJ, San Miguel JF, Ocio EM, Mateos MV. Randomized phase II study of weekly carfilzomib 70 mg/m 2 and dexamethasone with or without cyclophosphamide in relapsed and/or refractory multiple myeloma patients. Haematologica 2023; 108:2753-2763. [PMID: 37102598 PMCID: PMC10542845 DOI: 10.3324/haematol.2022.282490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/17/2023] [Indexed: 04/28/2023] Open
Abstract
In this randomized phase II study (GEM-KyCyDex, clinicaltrials gov. Identifier: NCT03336073), the combination of weekly carfilzomib 70 mg/m2, cyclophosphamide and dexamethasone (KCd) was compared to carfilzomib and dexamethasone (Kd) in relapsed/refractory multiple myeloma (RRMM) after 1-3 prior lines (PL). One hundred and ninety-seven patients were included and randomized 1:1 to receive KCd (97 patients) or Kd (100 patients) in 28-day cycles until progressive disease or unacceptable toxicity occurred. Patient median age was 70 years, and the median number of PL was one (range, 1-3). More than 90% of patients had previously been exposed to proteasome inhibitors, approximetely 70% to immunomodulators, and approximetely 50% were refractory to their last line (mainly lenalidomide) in both groups. After a median follow-up of 37 months, median progression-free survival (PFS) was 19.1 and 16.6 months in KCd and Kd, respectively (P=0.577). Of note, in the post hoc analysis of the lenalidomide-refractory population, the addition of cyclophosphamide to Kd resulted in a significant benefit in terms of PFS: 18.4 versus 11.3 months (hazard ratio =1.7, 95% confidence interval: 1.1-2.7; P=0.043). The overall response rate and the percentage of patients who achieved complete response was around 70% and 20% in both groups. The addition of cyclophosphamide to Kd did not result in any safety signal, except for severe infections (7% vs. 2%). In conclusion, the combination of cyclophosphamide with Kd 70 mg/m2 weekly does not improve outcomes as compared with Kd alone in RRMM after 1-3 PL, but a significant benefit in PFS was observed with the triplet combination in the lenalidomide-refractory population. The administration of weekly carfilzomib 70 mg/m2 was safe and convenient, and, overall, the toxicity was manageable in both arms.
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Affiliation(s)
- Borja Puertas
- Hematology Department, University Hospital of Salamanca/IBSAL/Cancer Research Center-IBMCC (USAL-CSIC), CIBERONC, Salamanca
| | - Verónica González-Calle
- Hematology Department, University Hospital of Salamanca/IBSAL/Cancer Research Center-IBMCC (USAL-CSIC), CIBERONC, Salamanca
| | - Anna Sureda
- Hematology Department, Institut Català D'Oncologia L'Hospitalet, Barcelona
| | - María José Moreno
- Hematology Department, Hospital Clínico Universitario Virgen De La Arrixaca, Murcia
| | - Albert Oriol
- Hematology Department, Institut Josep Carreras and Institut Catala d'Oncologia, Hospital Germans Trias i Pujol, Badalona
| | | | - Laura Rosiñol
- Department of Hematology, IDIBAPS, Hospital Clinic, Barcelona
| | - Jordi López
- Hematology Department, Hospital De La Santa Creu i Sant Pau, Barcelona
| | | | - Joaquín Martínez-Lopez
- Hematology Department, Hospital Universitario 12 de Octubre, Universidad Complutense, CNIO, Madrid
| | - Estrella Carrillo
- Department of Hematology, University Hospital Virgen del Rocio, Instituto de Biomedicina de Sevilla (IBIS/CISC), Sevilla
| | - Esther Clavero
- Hematology Department, Hospital Universitario Virgen De Las Nieves, Granada
| | | | - Beatriz Rey-Bua
- Hematology Department, University Hospital of Salamanca/IBSAL/Cancer Research Center-IBMCC (USAL-CSIC), CIBERONC, Salamanca
| | | | - Victoria Dourdil
- Hematology Department, Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza
| | - Felipe de Arriba
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, IMIB-Pascual Parrilla, Universidad de Murcia, Murcia
| | - Sonia González
- Hematology Department, Complexo Hospitalario Universitario De Santiago, Santiago de Compostela
| | | | - Miguel T. Hernández
- Hematology Department, Hospital Universitario De Canarias, San Cristóbal de La Laguna, Tenerife
| | | | - Joan Bargay
- Hematology Department, H. Universitario Son Llàtzer, IdIsBa, Mallorca
| | - Joan Bladé
- Department of Hematology, IDIBAPS, Hospital Clinic, Barcelona
| | - Juan José Lahuerta
- Hematology Department, Hospital Universitario 12 de Octubre, Universidad Complutense, CNIO, Madrid
| | - Jesús F. San Miguel
- Hematology Department, Clínica Universidad de Navarra, CIMA, IDISNA, CIBERONC, Pamplona
| | - Enrique M. Ocio
- Hematology Department, Hospital Universitario Marqués De Valdecilla (IDIVAL), Universidad De Cantabria, Santander, Spain
| | - María-Victoria Mateos
- Hematology Department, University Hospital of Salamanca/IBSAL/Cancer Research Center-IBMCC (USAL-CSIC), CIBERONC, Salamanca
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