Contributions
Abstract: PB1660
Type: Publication Only
Session title: Myeloma and other monoclonal gammopathies - Clinical
Background
Carfilzomib (CFZ) is a next-generation proteasome inhibitor currently approved in combination with lenalidomide and dexamethasone (KRd) or with dexamethasone alone (Kd) for treatment of multiple myeloma (MM) patients with at least one prior line of therapy in the Asia Pacific (APAC) region. Real-world evidence is crucial to understanding how CFZ-based regimens are used in practice.
Aims
To describe utilization of KRd and Kd in routine clinical practice in APAC, including treatment patterns, patient profile and reasons for discontinuation.
Methods
This prospective, single-arm cohort study recruited adults with relapsed or refractory MM who received ≥1 dose of CFZ in either a combination or monotherapy regimen and had received ≥1 prior line of MM treatment prior to CFZ initiation. Between July 2019 and June 2021, approximately 300 patients are anticipated to be enrolled in this study, with 25–100 patients from each included country/region. Medical history, patient characteristics and clinical data will be collected at baseline and throughout the 2-year observation period or until death, withdrawal of consent or loss of follow-up. Follow-up data will be collected through chart reviews every 3 months. Adverse events (AEs) leading to treatment discontinuation will be collected. The last patient record for the analysis will be collected no later than Q1, 2023.
Results
The first patient was enrolled on 10 July 2019. As of 10 September 2020, 126 patients have been included from five countries/regions: Australia (n=15), Hong Kong (n=2), Korea (n=95), Singapore (n=10) and Taiwan (n=4). To date, the regimens prescribed were KRd (63%), Kd (33%) and other CFZ-based regimens (4%), including triplet combinations with cyclophosphamide (n=4) and daratumumab (n=1). Overall, 29% of patients reported a history of hypertension, 9% of cardiac disorders, 8% of diabetes mellitus and 1% of pulmonary embolism, prior to CFZ initiation. On average, patients prescribed KRd were slightly younger than patients prescribed Kd. The majority of KRd patients (63.8%) had received one prior line of treatment, whereas nearly half of Kd patients (43.9%) had received ≥4 lines of prior treatment. Similar proportions of KRd (26.3%) and Kd (26.8%) populations were bortezomib refractory; 53.7% of Kd patients were lenalidomide refractory. For nearly all KRd patients (96.3%) and almost three-quarters of Kd patients (73.2%), the initial prescribed therapeutic CFZ dose was in accordance with the local product information: 27 and 56 mg/m2 twice weekly, respectively. As of September 2020, 67.5% and 51.2% of KRd and Kd patients, respectively, remained on CFZ treatment. The most common reason for CFZ discontinuation was disease progression/refractory disease (See Table). Overall, only five patients discontinued CFZ for treatment-related AEs.
Conclusion
This study investigates the real-world use of CFZ for relapsed/refractory MM in a predominantly Asian patient population from across the APAC region. Interim results confirm that the standard dosing schedules for KRd and Kd are well tolerated in real-world practice and suggest a very low rate of discontinuation due to CFZ-related AEs, even in the very late stages of MM. Further prospective data collection of patients in routine practice is ongoing to assess patterns of longer-term patient management, response, survival outcome and AEs, which will inform optimal use of CFZ.
Keyword(s): Multiple myeloma, Proteasome inhibitor
Abstract: PB1660
Type: Publication Only
Session title: Myeloma and other monoclonal gammopathies - Clinical
Background
Carfilzomib (CFZ) is a next-generation proteasome inhibitor currently approved in combination with lenalidomide and dexamethasone (KRd) or with dexamethasone alone (Kd) for treatment of multiple myeloma (MM) patients with at least one prior line of therapy in the Asia Pacific (APAC) region. Real-world evidence is crucial to understanding how CFZ-based regimens are used in practice.
Aims
To describe utilization of KRd and Kd in routine clinical practice in APAC, including treatment patterns, patient profile and reasons for discontinuation.
Methods
This prospective, single-arm cohort study recruited adults with relapsed or refractory MM who received ≥1 dose of CFZ in either a combination or monotherapy regimen and had received ≥1 prior line of MM treatment prior to CFZ initiation. Between July 2019 and June 2021, approximately 300 patients are anticipated to be enrolled in this study, with 25–100 patients from each included country/region. Medical history, patient characteristics and clinical data will be collected at baseline and throughout the 2-year observation period or until death, withdrawal of consent or loss of follow-up. Follow-up data will be collected through chart reviews every 3 months. Adverse events (AEs) leading to treatment discontinuation will be collected. The last patient record for the analysis will be collected no later than Q1, 2023.
Results
The first patient was enrolled on 10 July 2019. As of 10 September 2020, 126 patients have been included from five countries/regions: Australia (n=15), Hong Kong (n=2), Korea (n=95), Singapore (n=10) and Taiwan (n=4). To date, the regimens prescribed were KRd (63%), Kd (33%) and other CFZ-based regimens (4%), including triplet combinations with cyclophosphamide (n=4) and daratumumab (n=1). Overall, 29% of patients reported a history of hypertension, 9% of cardiac disorders, 8% of diabetes mellitus and 1% of pulmonary embolism, prior to CFZ initiation. On average, patients prescribed KRd were slightly younger than patients prescribed Kd. The majority of KRd patients (63.8%) had received one prior line of treatment, whereas nearly half of Kd patients (43.9%) had received ≥4 lines of prior treatment. Similar proportions of KRd (26.3%) and Kd (26.8%) populations were bortezomib refractory; 53.7% of Kd patients were lenalidomide refractory. For nearly all KRd patients (96.3%) and almost three-quarters of Kd patients (73.2%), the initial prescribed therapeutic CFZ dose was in accordance with the local product information: 27 and 56 mg/m2 twice weekly, respectively. As of September 2020, 67.5% and 51.2% of KRd and Kd patients, respectively, remained on CFZ treatment. The most common reason for CFZ discontinuation was disease progression/refractory disease (See Table). Overall, only five patients discontinued CFZ for treatment-related AEs.
Conclusion
This study investigates the real-world use of CFZ for relapsed/refractory MM in a predominantly Asian patient population from across the APAC region. Interim results confirm that the standard dosing schedules for KRd and Kd are well tolerated in real-world practice and suggest a very low rate of discontinuation due to CFZ-related AEs, even in the very late stages of MM. Further prospective data collection of patients in routine practice is ongoing to assess patterns of longer-term patient management, response, survival outcome and AEs, which will inform optimal use of CFZ.
Keyword(s): Multiple myeloma, Proteasome inhibitor