Lenalidomide plus dexamethasone is the standard of care for patients with relapsed multiple myeloma but efficacy is suboptimal, with an overall response rate of 60%. Now, results from the phase III ASPIRE trial, published in The
New England Journal of Medicine (online, 6 December 2014)
, suggest that adding a third drug, the proteasome inhibitor carfilzomib, significantly improves outcomes.
ASPIRE enrolled 792 patients with relapsed multiple myeloma and randomised them to receive lenalidomide plus dexamethasone alone or with carfilzomib. The trial was stopped early after interim analysis found that progression-free survival was significantly longer in the carfilzomib group, at 26.3 months versus 17.6 months in the control group (hazard ratio for progression or death 0.69, 95% confidence interval 0.57 to 0.83; P=0.0001).
Carfilzomib was also associated with an 87.1% overall response rate compared with 66.7% for the control group (P<0.001) and significantly better health-related quality of life.
 Stewart AK, Rajkumar SV, Dimopoulos MA et al; the ASPIRE Investigators. Carfilzomib, lenalidomide, and dexamethasone for relapsed multiple myeloma. The New England Journal of Medicine 2014. doi:10.1056/NEJMoa1411321.