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What is carfilzomib (Kyprolis®)?

Carfilzomib (Kyprolis) is a cancer medicine which has been approved in Europe for the treatment of relapsed multiple myeloma in adult patients who have had at least one previous treatment cycle. It was approved by the European Medicines Agency (EMA) in 2016 for use together with the medicines lenalidomide and dexamethasone or with dexamethasone alone.

 

How does carfilzomib work?

Carfilzomib is a proteasome inhibitor. This means that it blocks the proteasome, which is a system within the cells that breaks down proteins when they are no longer needed. When the proteasome is prevented from breaking down the proteins these accumulate in the cancer cells, which eventually die, slowing down the growth of the cancer. It is marketed by Amgen Europe B.V.

 

What are the benefits of carfilzomib?

Carfilzomib taken together with lenalidomide and dexamethasone (KRd) has been compared with lenalidomide plus dexamethasone (Rd) in a study involving 792 myeloma patients whose disease had got worse after previous treatment. Carfilzomib prolonged the average length of time before the patient’s disease got worse again (progression-free survival): patients receiving KRd lived for an average of 26.3 months without their disease getting worse, compared with 17.6 months for patients receiving only Rd. The study found that KRd improved global health status and quality of life without negatively affecting symptoms reported by patients compared with Rd.

 

What are the side effects?

The most common side effects (which may affect more than one in five people) are:

  • tiredness
  • anaemia (low red blood cell counts)
  • nausea (feeling sick)
  • thrombocytopaenia (low blood platelet counts)
  • difficulty breathing
  • diarrhoea
  • respiratory tract infection
  • cough
  • raised body temperature
  • swollen ankles and feet

 

The most common serious side effects are:

  • congestive heart failure
  • acute renal failure
  • pneumonia
  • fever

 

How and when is carfilzomib given?

Carfilzomib is given as an infusion (drip) into a vein at a hospital out-patients department or clinic, under the supervision of a doctor who specialises in the treatment of cancer. The starting dose is calculated using your height and weight. It may be increased if the medicine is well tolerated. Each infusion may last 10-30 minutes. It is given on two consecutive days each week for three weeks followed by a 12-day rest period. Each 28-day period is considered one treatment cycle. When carfilzomib is used with lenalidomide and dexamethasone it is known as KRd.

Before starting carfilzomib, you should have a full medical work-up (including blood pressure and fluid management). You should be closely monitored during treatment. If you have severe side effects, treatment may need to be stopped or the dose reduced. Contact your doctor immediately if you have fever, chills, shivering, chest pain, cough, or swelling of the feet or legs, bleeding, bruising, weakness, headaches, confusion, seizures, or loss of sight.

You should consult your doctor if you are, or think that you may be, pregnant or you are breastfeeding. Women should avoid becoming pregnant and men should avoid fathering a child during treatment with carfilzomib.

 

References

  • European Medicines Agency. Kyprolis (carfilzomib) European public assessment report (EPAR). Last updated 06/2016
  • http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/medicines/003790/human_med_001932.jsp&mid=WC0b01ac058001d124
  • Manufacturer’s product information https://www.kyprolis.eu/
  • Stewart AK et al. Carfilzomib, Lenalidomide, and Dexamethasone for Relapsed Multiple Myeloma. N Engl J Med 2015;372:142–152
  • Stewart AK et L. Health-Related Quality of Life Results From the Open-Label, Randomized, Phase III ASPIRE Trial Evaluating Carfilzomib, Lenalidomide, and Dexamethasone Versus Lenalidomide and Dexamethasone in Patients With Relapsed Multiple Myeloma. j Clin Oncol Published ahead of print September 6, 2016
  • Rajkumar, SV and Kumar, S. Multiple Myeloma: diagnosis and treatment. Mayo Clin Proc 2016;91(1):101-119
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