Weekly carfilzomib, cyclophosphamide, and dexamethasone in multiple myeloma

This paper studied the outcome of weekly carfilzomib, cyclophosphamide, and dexamethasone in patients with newly diagnosed multiple myeloma who cannot be treated with transplant. The authors concluded that this combination was effective in these patients.

Multiple myeloma is a cancer of the plasma cells of the blood. Treatment includes transplanting stem cells and chemotherapy. In patients who are older, transplants are not possible. Thus, treatment is with chemotherapy. Carfilzomib (Kyprolis) is a new drug used for patients with relapsed (cancer that has returned) and refractory (cancer that has not responded to treatment) multiple myeloma. It is safe and effective when used in combination with dexamethasone.  

Receiving treatment twice a week can be burdensome for patients. Earlier studies have found that a weekly treatment with bortezomib has similar effect as twice-weekly treatment. It is not clear whether once-weekly carfilzomib is as effective.

This study aimed to examine the effect of weekly treatment with carfilzomib, dexamethasone and dexamethasone.

Patients with newly diagnosed multiple myeloma who were not eligible for transplantation were studied. A total of 54 patients were treated at the recommended dose and were analyzed. The average age was 72 years. They received cyclophosphamide, dexamethasone and carfilzomib.

Among 54 patients receiving carfilzomib, 85% of patients had at least a partial response to treatment. 30% of patients had a near complete response to treatment. The average time to achieve a partial response to treatment was 2.4 months. The average time to achieve a complete response was 12 months. After an average follow-up of 19.7 months, 81% of patients survived at 2 years. 53.2% of patients survived without worsening disease.

With regards to safety, the most common adverse events (undesired effect of treatment) were low levels of white blood cells and red blood cells. Infections were seen in 13% of patients. 26% of patients had a serious adverse event when starting treatment, such as kidney failure, heart failure and infection.  

The authors concluded that a weekly treatment of carfilzomib, cyclophosphamide and dexamethasone is effective in elderly patients not eligible for transplant.

This is a phase 1 and phase 2 study. Further studies are needed.