What are the results from the ENDURANCE trial that compares KRd to VRd in newly diagnosed myeloma patients?
Question: What are the results from the ENDURANCE trial that compares KRd to VRd in newly diagnosed myeloma patients?
In this video, Dr Brian Durie discusses the results of the ENDURANCE trial presented at the 2020 ASCO meeting.
Both therapies showed similar lengths of remission. VRd remains the current standard of care for newly diagnosed multiple myeloma patients.
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This week’s “Ask Dr. Durie” comes from a questioner who’s aware of a new ASCO abstract presentation in which the combination of KRd was compared with VRd for newly diagnosed multiple myeloma.
And so, the combination of Kyprolis, Revlimid, and dex was compared with the combination of Velcade, Revlimid, and dex. This was a phase three randomized trial called the ENDURANCE trial, and encompassed all front-line patients except for those who had high risk features, so those patients were actually excluded from the trial, and also, those patients who were planning to have an up-front transplant. And so, this trial did not include all patients. And so, this is possible important in the interpretation of the results.
The results of the trial were very, very, clear. The primary endpoint for evaluation was “how long was the first remission?” What we call PFS, progression-free survival. And, the results were that the KRd and VRd had almost identical lengths of remission, right around thirty-one, thirty-two months. And so, there was really no doubt about impact on this first remission.
The other aspects that were important is that the types of toxicities with the two regimens were quite different, as one might expect, the Velcade, Revlimid, and dex patients had more neuropathy side effects, whereas, the patients receiving the Kyprolis had more cardiopulmonary and kidney toxicities. So, the outcome was rather clear and thus far also, indicated that there was no difference in the overall survival.
And, the BOTTOM LINE is that although not all patients were included in the trial, particularly those with high risk disease, for the majority of patients with myeloma in this newly diagnosed category, it seems that the Velcade, Revlimid, and dex combination does remain the standard of care for now. And, that the switching out of Velcade for Kyprolis did not provide any added benefit. So, a disappointing result for many, but it’s a helpful result many as well, because the Velcade, Revlimid, and dex is widely available and can provide excellent results.
Dr. Brian G.M. Durie serves as Chairman of the International Myeloma Foundation and serves on its Scientific Advisory Board. Additionally, he is Chairman of the IMF's International Myeloma Working Group, a consortium of nearly 200 myeloma experts from around the world. Dr. Durie also leads the IMF’s Black Swan Research Initiative®.