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Carfilzomib

Classification: A

Drug products: Kyprolis, KYPROLIS

ATC code: L01XG02

Substances: carfilzomib

Summary

Subgroup analysis of a large RCT shows positive effect of carfilzomib in both men and women. A post-hoc analysis of RCTs on the effect carfilzomib found female sex to be a predictor of better survival. As the drug could have teratogenic effects, contraception during and for 3-6 months after treatment is recommended in both men and women. More information about teratogenic aspects can be found in Janusmed Drugs and Birth Defects (in Swedish, Janusmed fosterpåverkan).

Additional information

Multiple myeloma is more common in men (incidence in the US: 7.7/100 000 men and 4.9/100 000 women, respectively) and two-fold more common in blacks than in whites in the US [1]. A retrospective data analysis,patients with multiple myelomas who underwent autologous stem cell transplantation (ASCT) (110 men, 81 women) found no differences between men and women in baseline characteristics or five-year overall survival rate [2].A population-based study in Medicare beneficiaries (1089 men, 1330 women) in the US found male sex to be a risk factor for death together with older age, more co-morbidities, anemia, and hypercalcemia [3]. This is in concordance with an analysis of the EUROCARE database which includes European adults (15-99 years of age, in all 35 086) diagnosed with multiple myeloma between 1995 and 1999. Women were found to have a higher survival rate compared to men, particularly in age groups over the age of 55 years [4]. In this study, age at diagnosis was the main determinant of women’s good outcome. In elderly women, however, the advantage was negligible, suggesting sex hormone patterns to have a role in the prognosis [4].

Pharmacokinetics and dosing

Patient’s sex has not been reported to have any clinically meaningful effects on pharmacokinetics of carfilzomib [5].

Effects

In the pivotal study in patients with relapsed multiple myeloma (449 men, 345 women), predefined subgroup analysis showed that progression free survival was better in both men and women treated with carfilzomib in combination with lenalidomide and dexamethasone (26.3 months) compared to those treated with lenalidomide and dexamethasone alone (17.6 months) [6].In a post-hoc analysis of overall survival on carfilzomib treatment in three clinical studies (in all 268 men, 184 women), female sex was one factor predicting better survival [7].

Adverse effects

Differences between men and women in cardiotoxicity has been analyzed in a small study (29 men, 21 women). Global longitudinal strain was decreased in patients treated with carfilzomib but no difference between men and women was found in multivariable regression analysis [8].

Reproductive health issues

Concomitant use of oral contraceptives (OC) is not recommended due to the risk of thrombosis but also as the risk of lower effect of the OC can’t be ignored [9]. Carfilzomib should be avoided during pregnancy as animal studies suggest teratogenic effects. Thus, it is recommended that women treated with carfilzomib (and/or their partner) use effective anticonception during and for six months after the treatment. For men, effective anticonception is recommended during and for three months after the treatment [5]. Regarding teratogenic aspects, please consult Janusmed Drugs and Birth Defects (in Swedish, Janusmed fosterpåverkan).

Updated: 2019-02-26

Date of litterature search: 2019-01-21

References

  1. Dimopoulos MA, Terpos E, Niesvizky R, Palumbo A. Clinical characteristics of patients with relapsed multiple myeloma. Cancer Treat Rev. 2015;41(10):827-35. PubMed
  2. Posch D, Rabitsch W, Wohlfarth P, Leiner M, Porpaczy E, Drach J et al. Gender-Specific Aspects in Patients with Multiple Myeloma Undergoing Autologous Stem Cell Transplantation: A Single-Center Experience. Oncology. 2017;93(5):295-301. PubMed
  3. Yusuf AA, Natwick T, Werther W, Felici D, Mahue M, Bridges KR et al. A retrospective analysis to examine factors associated with mortality in Medicare beneficiaries newly diagnosed with multiple myeloma. Curr Med Res Opin. 2016;32(12):1989-1996. PubMed
  4. Micheli A, Ciampichini R, Oberaigner W, Ciccolallo L, de Vries E, Izarzugaza I et al. The advantage of women in cancer survival: an analysis of EUROCARE-4 data. Eur J Cancer. 2009;45(6):1017-27. PubMed
  5. Kyprolis (carfilzomib) DailyMed. DailyMed [www]. US National Library of Medicine. [updated 2018-09-28, cited 2019-01-21]. länk
  6. Stewart AK, Rajkumar SV, Dimopoulos MA, Masszi T, Špička I, Oriol A et al. Carfilzomib, lenalidomide, and dexamethasone for relapsed multiple myeloma. N Engl J Med. 2015;372(2):142-52. PubMed
  7. Jonsson F, Ou Y, Claret L, Siegel D, Jagannath S, Vij R et al. A Tumor Growth Inhibition Model Based on M-Protein Levels in Subjects With Relapsed/Refractory Multiple Myeloma Following Single-Agent Carfilzomib Use. CPT Pharmacometrics Syst Pharmacol. 2015;4(12):711-9. PubMed
  8. Iannaccone A, Bruno G, Ravera A, Gay F, Salvini M, Bringhen S et al. Evaluation of Cardiovascular Toxicity Associated with Treatments Containing Proteasome Inhibitors in Multiple Myeloma Therapy. High Blood Press Cardiovasc Prev. 2018;25(2):209-218. PubMed
  9. Kyprolis (carfilzomib). Summary of Product Characteristics. European Medicines Agency (EMA) [updated 2018-10-18, cited 2019-01-21].
  10. Concise. Kalmar: eHälsomyndigheten. 2015 [cited 2018-12-17.] länk

Authors: Mia von Euler

Reviewed by: Mia von Euler

Approved by: Karin Schenck-Gustafsson