Current State of Carfilzomib Research for Resistant Multiple Myeloma
Posted: Wednesday, June 5, 2019
Carfilzomib is an effective non–first-line treatment of relapsed and/or refractory multiple myeloma. In a review article published in Cancer Management and Research, Inger S. Nijhof, MD , PhD, and colleagues, of the VU University Medical Center in Amsterdam, explored the results of current clinical trials of carfilzomib in seven different drug combinations and offered some insights for clinicians regarding its use.
“Carfilzomib is generally well tolerated and seems to be a safe treatment option in patients with renal impairment, patients with liver impairment, and patients with peripheral neuropathy. However, a slightly higher incidence of cardiovascular toxicity is seen [with carfilzomib],” the authors wrote.
The U.S. Food and Drug Administration has approved carfilzomib in combination with either dexamethasone or both dexamethasone and lenalidomide. There are ongoing phase III trials of its use in two other drug combinations: with isatuximab (and dexamethasone) and daratumumab (and dexamethasone). Phase I or II trials are underway for the use of carfilzomib in five additional treatment combinations: with panobinostat, vorinostat (and dexamethasone and lenalidomide), pomalidomide (and dexamethasone), ibrutinib (and dexamethasone), and selinexor (and dexamethasone).
The authors advised providers of carfilzomib to take care with elderly and cardiovascularly compromised patients. There is currently no screening tool for identifying patients at risk of a serious cardiovascular adverse event associated with carfilzomib. The authors recommended addressing cardiovascular risk factors that can be changed—such as hypertension, high cholesterol, tobacco use, hyperglycemia, or a risky diet—before starting carfilzomib. If a patient has a grade 3 or 4 cardiac event, a physician may decide to recommend resuming carfilzomib after recovery, but ideally at a lower dose.
Disclosure: The study authors’ disclosure information may be found at dovepress.com.