Improved Quality of Life Reported With Carfilzomib, Lenalidomide, and Dexamethasone in Relapsed Multiple Myeloma


Key Points

  • Patients with relapsed multiple myeloma receiving carfilzomib, lenalidomide, and dexamethasone had higher GHS/QoL scores over 18 cycles than did those receiving lenalidomide and dexamethasone.
  • Proportions of patients with ≥ 5- and ≥ 15-point improvements were higher in the KRd group.

As reported in the Journal of Clinical Oncology, Stewart et al found that treatment with carfilzomib (Kyprolis), lenalidomide (Revlimid), and dexamethasone (KRd) was associated with improved health-related quality of life vs lenalidomide/dexamethasone (Rd) in relapsed multiple myeloma in the phase III ASPIRE trial. They showed a significant progression-free survival benefit with KRd vs Rd, and a quality-of-life benefit with KRd was observed over 18 cycles of treatment on the EORTC (European Organisation for Research and Treatment of Cancer) QLQ-C30 (Quality-of-Life Questionnaire).

Study Details

In the current analysis, outcomes were assessed with the Global Health Status/Quality-of-Life (GHS/QoL) scale, the QLQ-C30 subscales for fatigue, nausea/vomiting, pain, physical functioning, role functioning, and the myeloma-specific QLQ-MY20 subscales for disease symptoms and adverse effects of treatment. The percentages of responders with ≥ 5- or ≥ 15-point improvement on GHS/QoL at each cycle were compared.

Quality-of-Life Outcomes

GHS/QoL scores were higher in patients treated with the three-drug regimen vs the two-drug regimen over 18 treatment cycles (P < .001). The predefined minimal important difference of 5 points was met at cycle 12 (5.6 points) and nearly met at cycle 18 (4.8 points). There were no differences between groups in other prespecified subscales.

Greater proportions of KRd patients met GHS/QoL responder definitions of ≥ 5- and ≥ 15-point improvement from baseline at cycles 3, 6, 12, and 18. For ≥ 5-point improvement, the differences were significant at cycle 12 (25.5% vs 17.4%, P < .01) and 18 (24.2% vs 12.9%, P < .001). For ≥ 15-point improvement, differences were also significant at cycle 12 (19.9% vs 12.4%, P < .01) and 18 (17.7% vs 10.6%, P < .01).

The investigators concluded: “KRd improves GHS/QoL without negatively affecting patient-reported symptoms when compared with Rd. These data further support the benefit of KRd in patients with relapsed multiple myeloma.”

The study was supported by Onyx Pharmaceuticals, an Amgen subsidiary.

Keith Stewart, MB, ChB, of the Mayo Clinic, Scottsdale, Arizona, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.