Dr. Hari on the Role of Carfilzomib, Pomalidomide, and Dexamethasone in R/R Myeloma

Parameswaran Hari, MD, MRCP, the Armand J. Quick/William F. Stapp Professor of Hematology, and the chief of the Division of Hematology/Oncology, Department of Medicine, at the Medical College of Wisconsin, discusses the efficacy of combination carfilzomib (Kyprolis), pomalidomide (Pomalyst), and dexamethasone in patients with relapsed/refractory multiple myeloma.

The combination of pomalidomide and dexamethasone was previously examined in a phase 2 study in which the regimen demonstrated a significant response rate in patients with relapsed/refractory disease, Hari says. Thus far, this combination has not been studied in a randomized clinical trial, although it has become apparent that a number of patients with multiple myeloma are sensitive to proteasome inhibitors (PIs), such as second-generation agent carfilzomib, Hari explains.

Additionally, patients who are receiving lenalidomide (Revlimid) maintenance therapy or a lenalidomide-containing second-line regimen may still be sensitive to pomalidomide following relapse, Hari notes. Due to this, the combination of carfilzomib, pomalidomide, and dexamethasone is an effective treatment regimen for patients with relapsed/refractory multiple myeloma, especially those who have previously received the first-generation PI bortezomib (Velcade), monoclonal antibodies, and lenalidomide. A combination of a newer immunomodulatory agent and a second-generation PI has a place in the relapsed/refractory armamentarium, Hari concludes.