Carfilzomib versus bortezomib in multiple myeloma that has not responded to treatment

This paper compared the use of carfilzomib (Kyprolis) and bortezomib (Velcade) in the treatment of multiple myeloma. This study concluded that carfilzomib was associated with a reduced risk of death compared with bortezomib.

Multiple myeloma is a cancer of the plasma cells. New treatments have led to longer survival in recent years. However, many patients do not respond to first treatments (refractory disease) or relapse (return of cancer). The survival rate after 5 years is about 50%. Bortezomib is a standard treatment for multiple myeloma that has not responded to treatment. Early results showed that the newer treatment carfilzomib improved time to disease progression compared to bortezomib. Long-term outcomes are not yet known.

This study included 929 patients with multiple myeloma who had received at least one previous round of treatment. 463 patients were randomly assigned to carfilzomib and dexamethasone (a steroid) treatment (group 1). 456 patients were randomly assigned to bortezomib and dexamethasone treatment (group 2). 

After an average follow-up period of 37.5 months, there were 189 deaths among those in group 1 and 209 among those in group 2. The average overall survival (time from treatment until death from any cause) in group 1 was 47.6 months. Average overall survival for group 2 was 40 months.

99% of patients in both groups had an adverse event (undesired effect of treatment). Common side effects included a low red blood count, diarrhea, fever, shortness of breath, fatigue and high blood pressure. 59% of group 1 patients and 40% of group 2 patients had serious adverse events. These included pneumonia, fever, shortness of breath, acute kidney failure, pulmonary embolism (clot in the blood vessels of the lung) and respiratory infection. Five patients in group 1 and two patients in group 2 died due to treatment side effects.

The authors concluded that patients who received carfilzomib had significant improvements in survival compared to patients who received bortezomib. 

Talk to your doctor about receiving carfilzomib for relapsed or refractory multiple myeloma.