Carfilzomib-containing combinations as frontline therapy for multiple myeloma: A meta-analysis of 13 trials.

OBJECTIVE: To investigate the activity and safety of carfilzomib-containing combinations as frontline therapy for multiple myeloma.

METHODS: We searched published carfilzomib reports for newly diagnosed multiple myeloma.

RESULTS: Thirteen trials were identified, covering 704 subjects. Pooled analysis showed that carfilzomib combinations as frontline therapy for multiple myeloma attained an impressive at least complete response (≥CR) rate of 21%, at least very good partial response (≥VGPR) rate of 68%, overall response rate (ORR) of 94%. The ≥CR rates of 18% pre-SCT were increased to 43% of post-ASCT, and 64% of postconsolidation (P<.001). For those patients receiving carfilzomib therapy, response quality improved further over time (≥CR rates of 10% after 2nd cycle, 20% after 4th cycle, 43% after 8th cycle; ≥VGPR of 29% after 2nd cycle, 68% after 4th cycle, 88% after 8th cycle). ≥CR rates of 49% from CFZ-LEN-DEX triplet regimen were higher than 18% from CFZ-CYC-DEX triplet regimen and 21% from CFZ-THA-DEX triplet regimen (P=.03).

CONCLUSIONS: Carfilzomib combinations could produce clinical benefits in newly diagnosed patients with multiple myeloma. High-quality response rate could be further improved through ASCT, consolidation therapy, and more cycles of chemotherapy even in the era of carfilzomib. CFZ-LEN-DEX could be a good combination regimen.