Dr. Fakhri on the Use of Carfilzomib in Multiple Myeloma

Bita Fakhri, MD, MPH, a professor of medicine in the Division of Hematology/Oncology at the University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, discusses the use of carfilzomib (Kyprolis) in the treatment of patients with multiple myeloma.

Currently, physicians use 2 factors to pick a regimen for a patient—transplant eligibility versus ineligibility and the genomics of their disease, says Fakhri. In transplant-ineligible patients, the use of carfilzomib, lenalidomide (Revlimid), and dexamethasone (KRd) is not universally endorsed because there is the risk of pulmonary toxicity. However, in the relapsed/refractory setting, physicians have encouraging phase II data that indicate an improvement in progression-free and overall survival.

Based on the data in this setting, it makes sense to choose KRd as induction therapy for relapsed patients, states Fakhri. Another important aspect to consider is the regimen’s toxicity profile. Bortezomib (Velcade) is known to cause debilitating neuropathy, so a patient who has bad neuropathy should be kept away from that agent, Fakhri says.