Hematologic Oncology Update, Issue 1, 2016 (Video Program)Available research data with carfilzomib- and bortezomib-based induction therapy for patients with multiple myeloma (MM)
2:39 minutes.
TRANSCRIPTION:
DR FONSECA: It would appear that carfilzomib is a better proteasome inhibitor. I don’t think that means that there is no role for bortezomib. And I anticipate we’ll be using bortezomib for a long time still to come. In general, with a change of schedule to weekly and the route of administration to subcutaneous, I think really ameliorated the risk for a serious peripheral neuropathy. Not to say that it doesn’t occur, and, of course, we must remain vigilant for that, but it’s actually much better tolerated. The carfilzomib really doesn’t have that high of a concern for neuropathy. And the combination is, in general, very, very well tolerated. I think one of the things that we have to be mindful, that there is a risk, as we know, of both hypertension and cardiac toxicity with a carfilzomib-based combination. Now, the absolute value for that — this has been demonstrated by the various trials, ENDEAVOR trial and the ASPIRE trial — is actually rather small. But that’s not to say that we should not pay attention to that, particularly in patients who would be at high risk for that or in patients who exhibit symptoms from that with administration of those drugs. So I think that extra level of caution, even if you talk about a 2% point difference in toxicity, it has to be considered as we think about moving these agents to the front-line therapy. Now again, people who’ve done clinical trials and who’ve worked extensively with the regimen, such as Dr Jakubowiak, Dr Landgren and others, really have shown through their clinical trials that this is a very effective and well-tolerated combination. Our experience in the clinic is that it is very well tolerated. It’s logistically, of course, a little bit more complicated because it takes the longer time of infusion, the intravenous route of administration. And for the most part, until we have results from the CHAMPION study, we continue to use it as per package insert with twice-per-week dosing. DR LOVE: As long as you brought that up, we did see some data at ASH in the relapsed/refractory setting of weekly carfilzomib. What was seen there? And do you think that is kind of going to become the way it’s going to be given in the near future? DR FONSECA: I think, because we already have a highly effective regimen, we’re having patients live for so much longer, this is one area where I’d normally like to go out a little bit more forward and then think, “Oh, we should be thinking about this.” I think this one is okay to be paused and wait for detailed toxicity data to come back before fully embracing that. I know in some situations we have used it on a weekly basis. But for the majority of patients, I continue to use it as per package insert. |