The preferred initial regimen for multiple myeloma is bortezomib, lenalidomide, and dexamethasone. Carfilzomib is a second-generation proteasome inhibitor that replaced bortezomib in the above regimen as first-line treatment in the ENDURANCE trial. In the refractory setting, carfilzomib seems more active than bortezomib, though it comes at the cost of considerable toxicity. So this could potentially influence the initial management of patients with multiple myeloma. The Betting Line: Carfilzomib will improve disease outcomes and overall survival with higher toxicity compared to bortezomib. | Kumar, ASCO 2020


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