Elotuzumab in Combination With Carfilzomib, Lenalidomide and Dexamethasone (E-KRd) Versus KRd in MM
Status:
Recruiting
Trial end date:
2029-08-01
Target enrollment:
Participant gender:
Summary
Of the next-generation compounds, the monoclonal antibodies (moAbs) have recently attracted a
lot of interest in MM. The anti-SLAMF7 directed moAb elotuzumab has completed phase III
trials in MM patients. One phase III trial in MM patients with one to three prior lines of
therapy compared elotuzumab-Rd with standard Rd. The triple combination was shown to
significantly prolong PFS in this patient cohort with a greater proportion of patients in at
least very good partial response (VGPR) when compared to subjects on Rd. Notably, the rate of
infusion-related reactions with this specific moAb was very low, with an overall rate of 10%
in premedicated patients and only 1% of Grade 3 severity. Grades 4/5 infusion-related
reactions were absent and only 1% of patients on elotuzumab discontinued for infusion-related
reactions. Of particular interest is the observation in this trial, that response and PFS
were independent of cytogenetic high-risk features, i.e., deletion of chromosome 17p and
translocation t(4;14). This effect distinguishes elotuzumab from most, if not all, other
drug-based approaches.
The investigators assume that incorporating the moAb into the KRd triple induction regimen
should result in an even higher rate of deep (negative for MRD in conjunction with at least
very good partial response [VGPR] as defined by the International Myeloma Working Group
[IMWG]) with these responses occurring independently of cytogenetic risk. Due to potential
interference of elotuzumab with serum immune fixation, the investigators chose VGPR rather
than complete response (CR) to exclude false-positive immunofixation results. Furthermore the
investigators hypothesize that combining elotuzumab with lenalidomide should prolong PFS
further.