One of the late breaking sessions at the American Society of Hematology meeting included results from a study looking at a completely new combination – carfilzomib, daratumumab and dexamethasone. The combination looks promising for patients who have become resistant to immunomodulators such as lenalidomide. This is significant because myeloma treatment is typically given with a triplet combination that includes a proteasome inhibitor, an immunomodulator and a steroid. Many patients use lenalidomide as maintenance therapy, but once they relapse after Revlimid, what are their options? Saad Usmani, MD of Atrium Health joined the Myeloma Crowd at ASH to share a new potential combination and results from the CANDOR study.
The study included 466 relapsed or refractory myeloma patients: 2/3 of the patients received carfilzomib/daratumumab/dex (KdD) and 1/3 of the patients received carfilzomib/dex (Kd). All of the patients had received 1-3 prior lines of therapy and the patients were treated until disease progression.
The study end point was progression free survival, or how long patients lived without relapsing. Progression free survival at 17 months was:
- 37% lowered risk of disease progression in the KdD arm
- Median progression free survival wasn’t reached by the end of 17 months for the KdD arm
- Median progression free survival was 15.8 months for the Kd arm
Overall response rates were as follows:
- 84.3% for KdD patients
- 74.7% for Kd patients
The depth of response was better as well. Minimal residual disease (MRD) negativity at one year was 10x better with the triplet combo:
- 12.5% for KdD patients
- 1.3% for Kd patients
“With the increasing use of frontline lenalidomide based therapies, there is an emerging need for lenalidomide-sparing regimens at relapse,” said Saad Usmani, M.D., chief of the Plasma Cell Disorders Division and the director of Clinical Research in Hematologic Malignancies, Atrium Health’s Levine Cancer Institute (LCI). “The CANDOR trial demonstrates the potential efficacy of a lenalidomide-sparing regimen that combines two effective targeted agents and provides deep and durable responses upon relapse.”
For relapsed patients, this additional combination will be a welcome one.