September 8, 2020
KRd Didn’t Outperform in Response Rates or Progression-Free Survival
- The ENDURANCE trial compared the three-drug combinations VRd and KRd
- KRd didn’t improve response rates or progression-free survival compared to VRd
- It’s possible that KRd could still be an option for younger patients with high-risk disease
The three-drug combination of bortezomib, lenalidomide, and dexamethasone (VRd) has been the standard therapy for patients with newly diagnosed multiple myeloma. The ENDURANCE trial presented at ASCO was a head-to-head effort to determine whether adding the next-generation proteasome inhibitor on the block, carfilzomib, to lenalidomide and dexamethasone (KRd) might perform even better. In short, it didn’t.
Approximately 83% of patients in the VRd treatment group experienced a partial response or better, compared to 86% of patients in the KRd group. Progression-free survival was similar between the two groups.
“KRd did not improve response rates or progression-free survival,” one of the study’s authors, Dr. Vincent Rajkumar of Mayo Clinic, says during a virtual multiple myeloma conference hosted by SurvivorNet Connect. What’s more, carfilzomib was more expensive and it led to serious cardiopulmonary side effects. “We concluded that VRd remains the standard of care.”
UCSF hematologist, Dr. Nina Shah, says she was surprised at the lack of difference between the two treatments. “KRd was the new and shiny tool that we had,” she says.
Yet KRd isn’t off the table completely. “The good news for patients is both of them performed very well,” says Dr. Paul Richardson of Dana-Farber Cancer Institute. “If I have a patient who I consider at risk for bortezomib-related neurotoxicity who doesn’t have cardiovascular risk, KRd is an excellent platform to pursue, but we do have choices.”
It’s possible that KRd might be an option for younger patients with high-risk disease, who were not included in this study. However, that remains to be seen. “I still feel that there are a group of patients who probably benefit from KRd upfront,” says hematologist-oncologist, Dr. Joshua Richter of Mount Sinai. “More study is needed.”
“There are more trials going on, and hopefully, they will give us more insight than we’ve had,” Dr. Rajkumar adds.