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What Does the ENDURANCE Trial Mean for Myeloma Patients?

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Published on June 12, 2020

In this segment from our recent Answers Now Program, patient advocate Jim Omel explains what the ENDURANCE trial is and shares the latest results. He and host Jack Aiello discuss side effects, pros and cons, and what it all means for their fellow myeloma patients. This trial was recently presented at the 2020 American Society of Clinical Oncology (ASCO) annual meeting. Watch now to learn more.

This is the first part of a five-part series. Watch Part 2 at CAR T-Cell Clinical Trial Updates for Myeloma Patients, Part 3 at What Does the StaMINA Trial Mean for Myeloma Patients? ,Part 4 at Treating Myeloma in Patients with Renal Insufficiency, and Part 5 at New Treatment Options Give Hope to Myeloma Patients .

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Transcript | What Does the ENDURANCE Trial Mean for Myeloma Patients?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Recorded on June 5, 2020

Jack Aiello:

I want to welcome my fellow patient advocates. We have Cindy Chmielewski from New Jersey joining us, I have Maddie Hunter from outside of New York City joining us, and Jim Omel from the great state of Nebraska with us. And together, we're going to talk about key takeaways that each of us saw at ASCO. 

So just to give you some background, what the heck is ASCO? Each June researchers from around the world gather to share their findings in Chicago, except this year with the COVID-19 this sharing of discoveries was done virtually. But nearly 43,000 attended from 138 countries to provide both oral and poster presentations with prerecorded videos and slides.        

While ASCO predominantly focuses on solid or tissue cancers, there were several excellent updates provided for the myeloma community. Why do you care about this? Well, with new research, it could change your treatment plan. The research could provide you with questions to ask your doctor. And ultimately like me, I think it gives you hope.          

So let's get started. I'll begin with Jim. Jim, tell us a bit about yourself and one of your key takeaways from ASCO.

Jim Omel:

Hi, Jack. Thanks so much. A bit about myself, I am a 73-year-old retired family physician. I've had myeloma since 1997, developed when I was 50 years old. I've been involved with lots of areas of myeloma research the last 20 years, and run a support group, and a lot of things related to myeloma that are important. ASCO itself is important as you said, because it's largely tissue-based. One of the important things about myeloma is that it's usually covered more at ASH. So to have a plenary session that involved myeloma is very important, a big honor.

Let me explain what plenary sessions are. At these big meetings, the most important abstracts are picked for a presentation to the whole audience, big meetings where everybody kind of comes and attends in the room at the same time. And one of these plenary sessions involved the ENDURANCE trial. The ENDURANCE trial asks an important question for newly diagnosed patients, what is my best treatment option? Several years ago, Dr. Brian Durie explained and showed that RVD; lenalidomide (Revlimid), bortezomib (Velcade), dexamethasone (Decadron), is an important induction treatment. It gives almost 100 percent overall response rate.  

So we ask the question now, could we do even better than that? Can we make the responses deeper? So this ENDURANCE trial compared RVD versus KRD, with K meaning carfilzomib (Kyprolis). So we're comparing three drugs head to head for newly diagnosed patients. These are patients that have standard risk myeloma, and it's a trial that actually ended up showing there wasn't a lot of difference. The trial had 34.6 months of freedom from having your myeloma with the Kyprolis arm and 34.4 months with the Velcade arm. In other words, they were essentially the same. We know from experience that KRD does better for relapsed patients, but we now know with this trial that KRD and VRD are equal for newly diagnosed patients.

There are significant differences, however, Jack, when it comes to side effects. The side effects of neuropathy were greater in about 8 percent versus 1 percent in the Velcade arm, and side effects of cardiopulmonary and renal, which means heart, lungs and kidney problems, were much more significant in the KRD or Kyprolis arms. And those numbers were 16 percent versus 5 percent. There's also a significant difference in cost. The KRD regimen for this treatment course is $315,000. The VRD cost is approximately $215,000, so $100,000 difference in cost.      

So what it really means is what we've known right along, and that is that myeloma treatment needs to be tailored for each individual patient. Each patient needs to discuss with their doctor what's best for them. If they have neuropathy, if they have some problems with their heart, with their kidneys, with their lungs, there are reasons why one of these regimens would be the best first treatment for patients versus the other one.

The actual outcome, Jack, is that VRD remains the superior induction triplet regimen. There's one more thing about this trial that we're still going to learn, and that is, will Revlimid for maintenance therapy best be used for two years, or should it be continued without stopping? That's an important extensive question and life-changing question with side effects. So this is an extremely important trial. I think it's why ASCO said this should be a plenary presentation. And I think we can all be proud of Dr. Shaji Kumar and the Alliance and ECOG and SWOG groups who put together this trial. It's an NCI trial, it's an important trial with good outcomes.

Jack Aiello:

So if I'm a standard risk patient, meaning I have no mutations among the various cytogenetics, like deletion 17 or translocations among different chromosomes, and I'm not planning on getting a transplant, that's what this trial intended to address, indicating that essentially, the two treatments, Kyprolis, Revlimid-dex and Velcade-dex are equivalent except that they have different side effect profiles. And so that's a question I should obviously ask my doctor in terms of which treatment is best for me going forward.

Jim Omel:

That's an excellent summary, Jack. That's just exactly it in a nutshell.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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