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Abstract：
Standard induction therapy for multiple myeloma is three-drug combination based on following classes of drugs: proteasome inhibitors, immunomodulators and steroids. Despite its notable efficacy, bortezomib has side effects like peripheral neuropathy (PNP) with reported incidence of grade ≥3 PNP between 2%-23% Schlafer et al., 2017. Carfilzomib (CFZ) has high selectivity and minimal off-target adverse effects including lower rates of PNP. CFZ is already approved for treatment of relapsed and refractory multiple myeloma (RRMM) as single agent as well as in combination with lenalidomide and/or dexamethasone. Extensive literature search identified a total of 1839 articles. Twenty-six articles (n = 5980) met the inclusion criteria, 15 in newly diagnosed multiple myeloma (NDMM) and 11 in RRMM group. CFZ demonstrates comparable or even better efficacy to bortezomib with much favorable AE profile. Deep, rapid and sustainable response using KRd with safer toxicity profile supports extension of KRd therapy to frontline therapy for all risk categories of MM. High incidence of grade ≥3 HTN underscores the importance of serial BP monitoring. In RRMM, CFZ has documented efficacy with standard 20-27mg/m2 dose. Further large-scale trials are needed to study benefit-to-risk profile of 20-56 and 20-70 mg/m2 dose of CFZ vs standard 20-27 mg/m2 dose in NDMM and RRMM.
摘要：
多发性骨髓瘤的标准诱导疗法是基于以下药物类别的三种药物组合：蛋白酶体抑制剂，免疫调节剂和类固醇。尽管它的功效显著，硼替佐米有副作用，如周围神经病变（PNP），据报道，≥3级PNP的发生率在2％-23％之间。,2017.卡非佐米(CFZ)具有高选择性和最小的脱靶副作用,包括较低的PNP比率。CFZ已经被批准作为单一药物以及与来那度胺和/或地塞米松组合用于治疗复发性和难治性多发性骨髓瘤(RRMM)。广泛的文献检索共发现1839篇文章。26篇(n=5980)符合纳入标准，初诊多发性骨髓瘤(NDMM)组15例，RRMM组11例。CFZ表现出与硼替佐米相当或甚至更好的功效,具有非常有利的AE概况。深,使用具有更安全毒性的KRd的快速和可持续反应支持将KRd治疗扩展到所有MM风险类别的一线治疗.≥3级HTN的高发生率强调了连续BP监测的重要性。在RRMM中,CFZ已记录了标准20-27mg/m2剂量的功效。需要进一步的大规模试验来研究NDMM和RRMM中20-56和20-70mg/m2剂量的CFZ与标准20-27mg/m2剂量的获益-风险特征。
