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卡非佐米-地塞米松与硼替佐米-地塞米松治疗复发/难治性多发性骨髓瘤:更新的总生存、安全性和亚组分析。

Carfilzomib-Dexamethasone Versus Bortezomib-Dexamethasone in Relapsed or Refractory Multiple Myeloma: Updated Overall Survival, Safety, and Subgroups.

机构信息

Department of Lymphoma and Myeloma, The University of Texas M.D. Anderson Cancer Center, Houston, TX.

Department of Hematology, University Hospital Hotel-Dieu, Nantes, France.

出版信息

Clin Lymphoma Myeloma Leuk. 2019 Aug;19(8):522-530.e1. doi: 10.1016/j.clml.2019.04.018. Epub 2019 May 2.

Abstract

INTRODUCTION

The phase III RandomizEd, OpeN Label, Phase 3 Study of Carfilzomib Plus DExamethAsone Vs Bortezomib Plus DexamethasOne in Patients With Relapsed Multiple Myeloma (ENDEAVOR) trial showed significantly improved progression-free survival and overall survival (OS) with carfilzomib (56 mg/m) and dexamethasone (Kd56) versus bortezomib and Kd56 (Vd) in patients with relapsed or refractory multiple myeloma (RRMM). We report updated OS and safety data after 6 months of additional follow-up.

PATIENTS AND METHODS

Patients with RRMM (1-3 previous lines of therapy) were randomized 1:1 to Kd56 or Vd. Median OS was estimated using the Kaplan-Meier method; OS was compared between treatment groups using Cox proportional hazards models.

RESULTS

As of July 19, 2017, median follow-up was 44.3 months for Kd56 and 43.7 months for Vd. Median OS was 47.8 months (Kd56) versus 38.8 months (Vd; hazard ratio, 0.76; 95% confidence interval, 0.633-0.915). OS was longer with Kd56 versus Vd within age and cytogenetic subgroups, and according to number of previous lines of therapy, previous bortezomib exposure, previous lenalidomide exposure, and lenalidomide-refractory status. Exposure-adjusted incidences per 100 patient-years of adverse events (AEs) were 1352.07 for Kd56 and 1754.86 for Vd; for Grade ≥3 AEs, these values were 162.31 and 175.90.

CONCLUSION

With median follow-up of approximately 44 months, clinically meaningful improvements in OS were observed with Kd56 versus Vd, including in all subgroups examined. The Kd56 safety profile was consistent with previous analyses.

摘要

简介

III 期随机、开放性、III 期 Carfilzomib 加地塞米松与硼替佐米加地塞米松治疗复发多发性骨髓瘤患者的研究(ENDEAVOR)表明,与硼替佐米加地塞米松(Vd)相比,复发或难治性多发性骨髓瘤(RRMM)患者的卡非佐米(56mg/m)和地塞米松(Kd56)可显著改善无进展生存期和总生存期(OS)。我们报告了在额外 6 个月随访后的更新 OS 和安全性数据。

患者和方法

RRMM(1-3 线治疗)患者按 1:1 随机分为 Kd56 或 Vd 组。采用 Kaplan-Meier 法估计中位 OS;采用 Cox 比例风险模型比较两组之间的 OS。

结果

截至 2017 年 7 月 19 日,Kd56 的中位随访时间为 44.3 个月,Vd 为 43.7 个月。中位 OS 为 47.8 个月(Kd56)与 38.8 个月(Vd;危险比,0.76;95%置信区间,0.633-0.915)。在年龄和细胞遗传学亚组、根据既往治疗线数、既往硼替佐米暴露、既往来那度胺暴露和来那度胺耐药状态,Kd56 组的 OS 均长于 Vd 组。每 100 患者-年的不良事件(AE)发生率为 1352.07 例(Kd56)和 1754.86 例(Vd);对于≥3 级 AE,这些值分别为 162.31 和 175.90。

结论

中位随访约 44 个月时,与 Vd 相比,Kd56 观察到 OS 的临床意义改善,包括所有检查的亚组。Kd56 的安全性特征与之前的分析一致。

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