Efficacy and toxicity profile of carfilzomib-based regimens for treatment of newly diagnosed multiple myeloma: A systematic review

Hassaan Imtiaz, Maimoona Khan, Hamid Ehsan, Ahsan Wahab, Abdul Rafae, Ali Y. Khan, Abdur Jamil, Muhammad Khawar Sana, Abdullah Jamal, Taimoor Jaffar Ali, Iqraa Ansar, Muzammil M. Khan, Jack Khouri, Faiz Anwer

Research output: Contribution to journalReview articlepeer-review

Abstract

Carfilzomib (CFZ) is a proteasome inhibitor currently approved for the treatment of relapsed and refractory multiple myeloma (RRMM). Multiple trials are ongoing to evaluate its efficacy and safety in newly diagnosed multiple myeloma (NDMM). The use of CFZ-based two-or three-drug combination regimens as induction for the management of NDMM is an emerging approach. CFZ-based regimens include combinations of immuno-modulators, alkylating agents, and monoclonal antibodies along with dexamethasone. In this review, we assess the efficacy and toxicity of CFZ-based regimens in NDMM. We reviewed a total of 27 studies (n=4538 patients) with overall response rates (ORR) ranging between 80% and 100%. Studies evaluating the combination of CFZ with daratumumab reported an ORR of approximately 100%. Achievement of minimal residual disease (MRD) negativ-ity, measured by multi-parameter flow cytometry (MPFC), ranged between 60% and 95% in 4 (n=251) out of 6 studies that measured MRD-negativity. The interim results of the ENDURANCE trial failed to show superior efficacy and progression-free survival (PFS) of carfilzomib-lenalidomide when compared to bortezomib–lenalidomide combination, albeit with a lower incidence of neuropathy. Hematological toxicity was the most common adverse event observed with these regimens, and the most common non-hematological adverse events were related to cardiovascular and electrolyte disturbances. We need to further evaluate the role of CFZ in NDMM by conducting more Phase III trials with different combinations.

Original languageEnglish (US)
Pages (from-to)4941-4960
Number of pages20
JournalOncoTargets and Therapy
Volume14
DOIs
StatePublished - Oct 2021

Keywords

  • Carfilzomib
  • Efficacy
  • Newly diagnosed multiple myeloma
  • Safety
  • Systematic review

ASJC Scopus subject areas

  • Oncology
  • Pharmacology (medical)

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