Dr. Paul on the Role of Carfilzomib in Relapsed/Refractory Multiple Myeloma

Barry A. Paul, MD, hematologist, Levine Cancer Institute, Atrium Health, discusses the role of carfilzomib (Kyprolis) in the treatment of patients with relapsed/refractory multiple myeloma.

Carfilzomib has demonstrated impressive efficacy in patients with relapsed/refractory disease, including those who are refractory to another proteasome inhibitor such as bortezomib (Velcade), says Paul.

However, the utility of carfilzomib is evolving as the drug is being given more frequently in the frontline setting, explains Paul. As such, patients who become refractory to carfilzomib in the first-line setting will not receive a carfilzomib-based regimen upon relapse.

The phase III ARROW study demonstrated prolonged progression-free survival with once-weekly carfilzomib at 70 mg/m² compared with twice-weekly carfilzomib at 27 mg/m². Moreover, the once-weekly regimen was associated with less toxicity versus the twice-weekly regimen, says Paul.

More patients who received once-weekly carfilzomib required dose reductions due to minor toxicities versus those who received the twice-weekly regimen, explains Paul. Additionally, more grade ≥3 adverse events were noted in patients who received carfilzomib once-weekly.

In October 2018, the FDA approved the once-weekly regimen of carfilzomib for use in combination with dexamethasone in patients with relapsed/refractory myeloma based on these data. The once-weekly regimen may provide a more convenient option for patients, concludes Paul.