Once-weekly carfilzomib combined with lenalidomide and dexamethasone for multiple myeloma

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Published: 25 Sep 2019
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Prof David Siegel - John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, USA

Prof David Siegel talks to ecancer at the International Myeloma Workshop 2019 about reducing carfilzomib combined with lenalidomide and dexamethasone to once-weekly.

He outlines the obvious benefits of this regime and how he believes a transition on to this regimen will be adopted.

ecancer's filming has been kindly supported by Amgen through the ecancer Global Foundation. ecancer is editorially independent and there is no influence over content.

One of the posters that we presented at this meeting was a phase Ib study of KRd, so carfilzomib, lenalidomide and dexamethasone. Carfilzomib, lenalidomide and dexamethasone has become one of the staple combinations used in the treatment of multiple myeloma from newly diagnosed patients to multiply relapsed patients. One of the issues that has always existed with carfilzomib is that it is used twice weekly so it’s Monday, Tuesday, Monday, Tuesday, Monday, Tuesday and then a week off. For patients that’s very demanding, for the infrastructure it’s very demanding. There have been recent studies that have looked at once weekly carfilzomib administration, just carfilzomib and dexamethasone once weekly compared to carfilzomib and dexamethasone twice weekly. Those trials, perhaps surprisingly, showed that once weekly carfilzomib and dexamethasone was not only just as effective but less toxic than the twice weekly administration. So there’s been much enthusiasm about once weekly administration.

However, carfilzomib’s most common partner is Revlimid and that combination with once weekly carfilzomib, Revlimid and dexamethasone has not been explored as of yet. So this is an abstract looking at that once weekly version of this very popular KRd combination. What this shows is that, perhaps as expected, it is very effective, it is fairly well tolerated and I think we’re going to see much migration from twice weekly KRd towards once weekly KRd as this database gets larger.

Are there toxicities?

The answer is yes, there are toxicities associated with carfilzomib, there are toxicities associated with Revlimid and there are toxicities associated with dexamethasone. I think the important point here is that there were no new toxicities. It wasn’t that giving a bigger dose once a week versus a smaller dose twice a week that there was not any new signal that would make us feel that this was going to be an unmanageable approach.