Dong Sharlene, Banerjee Rahul, Khan Adeel M, Wang Mengru, Wang Xiaoliang, Afghahi Anosheh, Afrough Aimaz, Janakiram Murali, Wang Bo, Cowan Andrew J, Sperling Adam S, Anderson Larry D, Rajkumar S Vincent, Kaur Gurbakhash
Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.
Fred Hutchinson Cancer Center, Seattle, WA, USA.
Blood Cancer J. 2025 Mar 28;15(1):48. doi: 10.1038/s41408-025-01256-2.
Despite the widespread use of carfilzomib (K) in relapsed/refractory multiple myeloma (RRMM), there is no consensus on optimal K dose in milligrams per square meter (mg/m2) or dosing schedule. We assessed three modern K prescribing patterns in RRMM using a large United States electronic health record-derived database. Our final cohort (n = 486) included 136 patients (28.0%) who received K 56 mg/m2 once weekly (K56-1x), 86 (17.7%) who received 56 mg/m2 twice weekly (K56-2x), and 264 (54.3%) who received 70 mg/m2 once weekly (K70-1x). Between 2016 and 2023, once-weekly dosing became more common: K70-1x proportions changed from 21.1% in 2016 to 50.6% in 2023, K56-1x from 15.8% to 37.0%, and K56-2x from 63.2% to 12.3%. Median progression-free survival was 13.0 months [95% confidence interval (CI) 11.2-20.7] for K56-1x, 13.2 months (95% CI 9.0-28.1 months) for K56-2x, and 10.9 months (95% CI 9.9-15.3 months) for K70-1x; these differences were not statistically significant (log-rank p = 0.46). Rates of heart failure was comparable (<5% in all cohorts). In summary, our findings do not support improved outcomes with twice-weekly carfilzomib in RRMM. K56-1x may provide the best balance of efficacy, safety, and avoidance of time toxicity from frequent infusions.
尽管卡非佐米（K）在复发/难治性多发性骨髓瘤（RRMM）中广泛应用，但对于每平方米毫克（mg/m²）的最佳K剂量或给药方案尚无共识。我们使用一个来自美国大型电子健康记录数据库评估了RRMM中三种现代K给药模式。我们的最终队列（n = 486）包括136名患者（28.0%）接受每周一次K 56 mg/m²（K56-1x），86名患者（17.7%）接受每周两次56 mg/m²（K56-2x），以及264名患者（54.3%）接受每周一次70 mg/m²（K70-1x）。在2016年至2023年期间，每周一次给药变得更为常见：K70-1x的比例从2016年的21.1%变为2023年的50.6%，K56-1x从15.8%变为37.0%，K56-2x从63.2%变为12.3%。K56-1x的无进展生存期（PFS）中位数为13.0个月[95%置信区间（CI）11.2 - 20.7]，K56-2x为13.2个月（95% CI 9.0 - 28.1个月），K70-1x为10.9个月（95% CI 9.9 - 15.3个月）；这些差异无统计学意义（对数秩检验p = 0.46）。心力衰竭发生率相当（所有队列均<5%）。总之，我们的研究结果不支持RRMM中每周两次卡非佐米能改善预后。K56-1x可能在疗效、安全性以及避免频繁输注导致的时间毒性之间提供最佳平衡。
