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1828 Weekly Carfilzomib, Cyclophosphamide and Dexamethasone (wCCyd) in Elderly Newly Diagnosed Multiple Myeloma Patients: Results of a Phase 2 Study

Myeloma: Therapy, excluding Transplantation
Program: Oral and Poster Abstracts
Session: 653. Myeloma: Therapy, excluding Transplantation: Poster I
Saturday, December 5, 2015, 5:30 PM-7:30 PM
Hall A, Level 2 (Orange County Convention Center)

Sara Bringhen1*, Davide Rossi, MD, PhD2, Alessandra Larocca1*, Paolo Corradini2, Piero Galieni2*, Alessandra Malfitano1*, Simona Aschero1*, Massimo Offidani2, Anna Marina Liberati2, Mariella Genuardi1*, Gianluca Gaidano2, Carmela Palladino1*, Fabiana Gentilini2*, Mario Boccadoro, MD1, Pieter Sonneveld, MD, PhD3 and Antonio Palumbo1

1Myeloma Unit, Division of Hematology, University of Torino, Torino, Italy
2Italian Multiple Myeloma Network, GIMEMA, Italy
3Department of Hematology, Erasmus MC, Rotterdam, Netherlands

Background Carfilzomib is a novel second generation proteasome-inhibitor with significant anti-MM activity and favorable toxicity profile. In a recent phase 1/2 study in relapsed/refractory patients (pts) a weekly schedule of carfilzomib in combination with dexamethasone showed to be effective (overall response rate of 77%) and safe (ASCO 2015). The ongoing phase 3 ARROW study is comparing once- with twice-weekly carfilzomib.

In the newly diagnosed setting, no data are available on weekly carfilzomib. We designed a phase 1/2 study of weekly carfilzomib in combination with cyclophosphamide and dexamethasone  (wCCyd) for newly diagnosed MM pts.

Results of the dose-escalation phase 1 portion of study were previously reported (Palumbo A et al, Blood 2014), the maximum tolerated dose of weekly carfilzomib was established as 70 mg/m2. Here we report efficacy and safety results of the phase 2 portion of the study.

Methods Newly diagnosed pts ineligible for autologous stem-cell transplantation due to age or co-morbidities were enrolled in the phase 2 portion of the study. Pts received IV carfilzomib at the maximum tolerated dose 70 mg/m2 on days 1, 8, 15 combined with oral cyclophosphamide at 300 mg/m2 on days 1, 8, 15 and oral dexamethasone at 40 mg on days 1, 8, 15, 22, in 28-day cycles. After the completion of 9 cycles, pts received 28-day maintenance cycles with carfilzomib at 70 mg/m2 on days 1, 8, 15 until disease progression or intolerance. The primary objectives were to determine the efficacy and safety of wCCyd. The secondary objectives included the evaluation of time to progression, progression-free survival, time to next therapy and overall survival. Response was assessed according to the modified International Uniform Response Criteria. Adverse events (AEs) were graded following NCI-CTCAE v4.

Results As of July 15, 2015, 47 newly diagnosed MM pts were enrolled in the phase 2 portion of the study. Median age was 72 years, 23% of pts were older than 75 years, 30% had ISS stage III, 34% had unfavorable FISH profile [t(4;14) or t (14;16) or del17p or amp1]. Toxicity and response data were available in 40 pts, who completed at least the first cycle; 7 pts were still receiving their first cycle of treatment. Pts received a median of 6 cycles (range 1-9). Overall, 80% of pts achieved at least a partial response, 60% at least a very good partial response, and 28% a near complete response. Responses improved over time (Table 1). During the study, 9 pts progressed or died, the progression-free survival at 1 year was 75%.

Grade (G) 3-4 drug-related adverse events included neutropenia (22%, 9 pts), thrombocytopenia (7%, 3 pts), infection (10%, 4 pts), acute pulmonary edema (5%, 2 pts), creatinine increase (5%, 2 pts), fever (2.5%, 1 pt), fatigue (2.5%, 1 pt) and headache (2.5%, 1 pt). G1-2 hypertension was reported in 6 pts (15%). No peripheral neuropathy was reported. Overall, the wCCyd regimen was well tolerated, 4 pts (10%) required carfilzomib dose-reduction (G3 hematologic toxicities [2 pts], G3 headache [1 pt] and G2 fatigue [1 pt]) and 9 pts (22%) required treatment discontinuation due to adverse events (2 infections, 1 acute pulmonary edema, 1 creatinine increase, 1 fever, 1 pt condition, 1 second tumor, 1 pericardial effusion, 1 sudden death).

Conclusions This is the first prospective study evaluating once-weekly carfilzomib in treatment-naïve MM. wCCyd therapy appears safe and effective in newly diagnosed MM pts. Responses became deeper with subsequent cycles and toxicities were manageable. The response rate observed with weekly carfilzomib compares favorably with similar studies with standard twice-weekly carfilzomib infusion. Updated results will be presented at the meeting.

Table 1.

2nd cycle

6th cycle

9th cycle

Complete Response

17%

26%

33%

At least near Complete Response

29%

39%

40%

At least Very Good Partial Response

66%

82%

87%

At least Partial Response

86%

87%

87%

Disclosures: Bringhen: Janssen-Cilag, Celgene, Novartis: Honoraria ; Onyx: Consultancy ; Merck Sharp & Dohme: Membership on an entity’s Board of Directors or advisory committees . Off Label Use: Use off-label of drugs for the dose and/or schedule and/or association . Larocca: Janssen-Cilag, Celgene: Honoraria . Offidani: Janssen-Cilag, Celgene, Sanofi, Amgen, Mundipharma: Honoraria . Gaidano: Celgene, Onyx: Membership on an entity’s Board of Directors or advisory committees . Boccadoro: Sanofi: Consultancy , Membership on an entity’s Board of Directors or advisory committees ; Celgene: Consultancy , Membership on an entity’s Board of Directors or advisory committees ; Onyx Pharmaceuticals: Consultancy , Membership on an entity’s Board of Directors or advisory committees ; Janssen-Cilag: Consultancy , Membership on an entity’s Board of Directors or advisory committees . Sonneveld: Janssen-Cilag, Celgene, Onyx, Karyopharm: Honoraria , Research Funding ; novartis: Honoraria . Palumbo: Celgene, Millennium Pharmaceuticals, Amgen, Bristol-Myers Squibb, Genmab, Janssen-Cilag, Onyx Pharmaceuticals: Consultancy , Honoraria ; Novartis, Sanofi Aventis: Honoraria .

*signifies non-member of ASH