Carfilzomib, pomalidomide, and dexamethasone for relapsed or refractory myeloma

Jatin J. Shah, Edward A. Stadtmauer, Rafat Abonour, Adam D. Cohen, William I. Bensinger, Cristina Gasparetto, Jonathan L. Kaufman, Suzanne Lentzsch, Dan T. Vogl, Christina L. Gomes, Natalia Pascucci, David D. Smith, Robert Z. Orlowski, Brian G.M. Durie

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136 Scopus citations

Abstract

Treatment options for patients with heavily pretreated relapsed and/or refractory multiple myeloma remain limited.We evaluated a novel therapeutic regimen consisting of carfilzomib, pomalidomide, and dexamethasone (CPD) in an open-label, multicenter, phase 1, dose-escalation study. Patients who relapsed after prior therapy or were refractory to the most recently received therapy were eligible. All patients were refractory to prior lenalidomide. Patients received carfilzomib IV on days 1, 2, 8, 9, 15, and 16 (starting dose of 20/27 mg/m2), pomalidomide once daily on days 1 to 21 (4mg as the initial dose level), and dexamethasone (40 mg oral or IV) on days 1, 8, 15, and 22 of 28-day cycles. The primary objective was to evaluate the safety and determine the maximum tolerated dose(MTD)of the regimen. A total of 32 patients were enrolled. The MTD of the regimen was dose level 1 (carfilzomib 20/27mg/m2, pomalidomide 4 mg, dexamethasone 40 mg). Hematologic adverse events (AEs) occurred in ≥60%of all patients, including11patients with grade ≥3 anemia. Dyspnea was limited to grade 1/2 in 10 patients. Peripheral neuropathy was uncommon and limited to grade 1/2. Eight patients had dose reductions during therapy, and 7 patients discontinued treatment due to AEs. Two deaths were noted on study due to pneumonia and pulmonary embolism (n51each).The combination of CPD is well-tolerated and highly active in patients with relapsed/refractory multiple myeloma. This trial was registered at www.clinicaltrials.gov as #NCT01464034.

Original languageEnglish (US)
Pages (from-to)2284-2290
Number of pages7
JournalBlood
Volume126
Issue number20
DOIs
StatePublished - Nov 12 2015

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ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

Cite this

Shah, J. J., Stadtmauer, E. A., Abonour, R., Cohen, A. D., Bensinger, W. I., Gasparetto, C., Kaufman, J. L., Lentzsch, S., Vogl, D. T., Gomes, C. L., Pascucci, N., Smith, D. D., Orlowski, R. Z., & Durie, B. G. M. (2015). Carfilzomib, pomalidomide, and dexamethasone for relapsed or refractory myeloma. Blood, 126(20), 2284-2290. https://doi.org/10.1182/blood-2015-05-643320