Dr. Landgren on Combinations in Newly Diagnosed Myeloma

C. Ola Landgren, MD, PhD, a senior investigator in the Multiple Myeloma Section of the National Cancer Institute, discusses a phase II trial that explored the combination of carfilzomib, lenalidomide, and dexamethasone followed by maintenance lenalidomide in patients with newly diagnosed multiple myeloma.

In the study, patients received 8 cycles of the combination therapy followed by 24 cycles of monthly lenalidomide. Carfilzomib was initially administered at 20 mg/m² but was later switched to 36 mg/m² on days 1, 2, 8, 9, 15, and 16 of each 28-day cycle. Lenalidomide was administered at 25 mg days 1-21 and dexamethasone was administered weekly at varying doses and administration routes.

The study was open to patients of all ages and did not have an upper cutoff for age, since transplantation was not involved, Landgren points out. Overall, the median age of patients in the study was 60 years old. A high-sensitivity, 8-color flow cytometry panel was utilized to assess minimal residual disease (MRD).

After administering the treatment to 45 patients, the overall complete response rate was 76%, states Landgren. All patients tested MRD-negative following the initial 8 cycles of therapy.

The key questions for this research going forward, Landgren states, is whether the MRD-negative rate persists in patients on maintenance therapy. Additionally, the MRD rate following a complete course of maintenance therapy will be the topic of future discovery.