A study of carfilzomib and dexamethasone in patients with relapsed and refractory multiple myeloma in China

Int J Hematol. 2021 Mar;113(3):422-429. doi: 10.1007/s12185-020-03044-z. Epub 2021 Jan 3.

Abstract

The second-generation proteasome inhibitor carfilzomib produces superior outcomes in relapsed or refractory multiple myeloma (MM). We conducted a single-arm trial of twice-weekly carfilzomib (27 mg/m2)-dexamethasone (Kd27) for relapsed and refractory MM in China. Kd27 was administered in 28-day cycles to 123 patients previously treated with ≥ 2 other regimens, including treatment with bortezomib and an immunomodulatory drug, and refractory to their most recent therapy. Overall response rate (ORR) was the primary endpoint; progression-free survival (PFS) and overall survival (OS) were key secondary endpoints. Primary analysis was conducted when all patients received ≥ 6 cycles of Kd27 or discontinued Kd27. Median age was 60 years; median number of prior regimens was 4; 74% were refractory to proteasome inhibitors and immunomodulatory drugs. ORR was 35.8% (95% CI 27.3-44.9), median PFS was 5.6 (95% CI 4.6-6.5) months, and median OS was 16.6 (95% CI 12.2-NE) months. Grade ≥ 3 adverse events (AEs) occurred in 76.4% of patients. Grade ≥ 3 AEs of interest included hypertension (13.8%), acute renal failure (3.3%), cardiac failure (0.8%), ischemic heart disease (0.0%), and peripheral neuropathy (0.0%); 5.7% of patients discontinued carfilzomib due to AEs. Carfilzomib-dexamethasone produced a clinically meaningful response without new safety findings in Chinese patients with previously treated MM.Trial registration: NCT03029234.

Keywords: Carfilzomib; China; Proteasome inhibitor; Relapsed and refractory multiple myeloma; Single-arm.

MeSH terms

  • Acute Kidney Injury / chemically induced
  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • China
  • Combined Modality Therapy
  • Dexamethasone / administration & dosage
  • Dexamethasone / adverse effects
  • Drug Resistance, Neoplasm
  • Female
  • Heart Diseases / chemically induced
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Hypertension / chemically induced
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Multiple Myeloma / drug therapy*
  • Multiple Myeloma / therapy
  • Oligopeptides / administration & dosage
  • Oligopeptides / adverse effects
  • Peripheral Nervous System Diseases / chemically induced
  • Progression-Free Survival
  • Recurrence
  • Salvage Therapy*

Substances

  • Oligopeptides
  • carfilzomib
  • Dexamethasone

Associated data

  • ClinicalTrials.gov/NCT03029234