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Carfilzomib
Source: Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: April 25, 2025 · Captured 2026-09-09.
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Carfilzomib is a second-generation proteasome inhibitor that is given by IV (unlike the subcutaneous route for bortezomib). Most studies have used twice-weekly administration, but once-weekly administration appears at least equally efficacious and safe.[26]
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Evidence (carfilzomib):
A prospective randomized trial included 578 patients with relapsed or refractory myeloma.[26]
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A prospective randomized trial included 578 patients with relapsed or refractory myeloma.[26]
The median PFS of patients who received carfilzomib once a week was significantly better (11.2 months; 95% CI, 8.6‒13.0) than twice a week (7.6 months; 95% CI, 5.8‒9.2) (HR, 0.69; 95% CI, 0.54‒0.83; P = .0029).[26][Level of evidence B1]
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In a prospective randomized trial of 792 patients with relapsed or refractory myeloma, the combination of carfilzomib, lenalidomide, and dexamethasone was compared with Rd.[27]
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In a prospective randomized trial of 792 patients with relapsed or refractory myeloma, the combination of carfilzomib, lenalidomide, and dexamethasone was compared with Rd.[27]
With a median follow-up of 67.1 months, median OS in the carfilzomib arm was 48.3 months (95% CI, 42.4‒52.8) versus 40.4 months (95% CI, 33.6‒44.4) (HR, 0.79; 95% CI, 0.67‒0.95; one-sided P = .009).[27][Level of evidence A1]
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In a prospective randomized trial of 792 patients with relapsed or refractory myeloma, the combination of carfilzomib, lenalidomide, and dexamethasone was compared with Rd.[27]
In a preplanned subgroup analysis, patients with high-risk cytogenetics (i.e., t(4;14), t(14;16), del(17p)) also had improved PFS with the triplet regimen (23 months vs. 14 months; HR, 0.70; 95% CI, 0.43−1.16; one-sided P = .083). Response rates were also improved, but the carfilzomib combination did not abrogate the worse prognosis.[28][Level of evidence B3]
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A prospective randomized study (NCT01568866) of 929 patients compared carfilzomib and dexamethasone with bortezomib and dexamethasone.[29]
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A prospective randomized study (NCT01568866) of 929 patients compared carfilzomib and dexamethasone with bortezomib and dexamethasone.[29]
With a median follow-up of 37 months, the median OS was 47.6 months (95% CI, 42.5–not evaluable) for the carfilzomib combination compared with 40.0 months (95% CI, 32.6–42.3) for the bortezomib combination (HR, 0.79; 95% CI, 0.65–0.96; P = .020).[29][Level of evidence A1]
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Cardiovascular adverse events such as heart failure, chest pain, and acute coronary syndrome (grade 3 or higher) occurred in 25% of patients, especially in the first 3 months of therapy.[30,31]
A systematic review and meta-analysis demonstrated that renal adverse events occurred in 21% of patients of patients who received carfilzomib, and 8.3% had grade 3 to 5 toxicities. Acute kidney injury was the most common renal toxicity.[32]
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Studies cited in this source section
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Preserved source evidence · Not medical advice