Carfilzomib prescribing patterns and outcomes for relapsed or refractory multiple myeloma: a real-world analysis
Despite the widespread use of carfilzomib (K) in relapsed/refractory multiple myeloma (RRMM), there is no consensus on optimal K dose in milligrams per square meter (mg/m2) or dosing schedule. We assessed three modern K prescribing patterns in RRMM using a large United States electronic health record-derived database. Our final cohort (n = 486) included 136 patients (28.0%) who received K 56 mg/m2 once weekly (K56-1x), 86 (17.7%) who received 56 mg/m2 twice weekly (K56-2x), and 264 (54.3%) who received 70 mg/m2 once weekly (K70-1x). Between 2016 and 2023, once-weekly dosing became more common: K70-1x proportions changed from 21.1% in 2016 to 50.6% in 2023, K56-1x from 15.8% to 37.0%, and K56-2x from 63.2% to 12.3%. Median progression-free survival was 13.0 months [95% confidence interval (CI) 11.2-20.7] for K56-1x, 13.2 months (95% CI 9.0-28.1 months) for K56-2x, and 10.9 months (95% CI 9.9-15.3 months) for K70-1x; these differences were not statistically significant (log-rank p = 0.46). Rates of heart failure was comparable (<5% in all cohorts). In summary, our findings do not support improved outcomes with twice-weekly carfilzomib in RRMM. K56-1x may provide the best balance of efficacy, safety, and avoidance of time toxicity from frequent infusions.
Authors
- Adeel Khan (ORCID: https://orcid.org/0000-0002-9462-6316)
- Aimaz Afrough (ORCID: https://orcid.org/0000-0003-2645-8557)
- Sharlene Dong
- Rahul Kumar Banerjee (ORCID: https://orcid.org/0000-0003-3781-5441)
- Andrew J. Cowan (ORCID: https://orcid.org/0000-0002-1880-7094)
- Larry D. Anderson (ORCID: https://orcid.org/0000-0002-6531-9595)
- Murali Janakiram (ORCID: https://orcid.org/0000-0001-9323-8007)
- Gurbakhash Kaur (ORCID: https://orcid.org/0000-0002-2510-6536)
- S. Vincent Rajkumar (ORCID: https://orcid.org/0000-0002-5862-1833)
- Mengru Wang (ORCID: https://orcid.org/0000-0002-2543-4871)
- Adam S. Sperling (ORCID: https://orcid.org/0000-0002-9369-4413)
- Anosheh Afghahi (ORCID: https://orcid.org/0000-0003-1225-406X)
- Bo Wang (ORCID: https://orcid.org/0000-0002-3307-6058)
- Xiaoliang Wang (ORCID: https://orcid.org/0000-0001-5184-2935)
Institutions
- Mount Sinai Hospital (US)
- Fred Hutch Cancer Center (US)
- Southwestern Medical Center (US)
- City of Hope (US)
- Dana-Farber Cancer Institute (US)
- Mayo Clinic in Arizona (US)
- Willamette Valley Cancer Institute and Research Center (US)
- Flatiron Health (United States) (US)
- Southwestern Medical Center (US)
- The University of Texas Southwestern Medical Center (US)
- Icahn School of Medicine at Mount Sinai (US)
Publication Details
- Journal
- Blood Cancer Journal
- Published
- 2025-03-28
- DOI
- https://doi.org/10.1038/s41408-025-01256-2
- Citations
- 4
- Primary Topic
- Multiple Myeloma Research and Treatments
- Type
- article
- Field-Weighted Citation Impact
- 7.08