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，但目前对于每平方米毫克数（mg/m²）的最佳剂量或给药方案尚未达成共识。我们利用美国大型电子健康记录数据库评估了RRMM中三种现代卡非佐米处方模式。最终队列（n=486）包括：136例患者（28.0%）接受每周一次56 mg/m²（K56-1x），86例（17.7%）接受每周两次56 mg/m²（K56-2x），264例（54.3%）接受每周一次70 mg/m²（K70-1x）。2016年至2023年间，每周一次给药方案日益普遍：K70-1x比例从2016年的21.1%升至2023年的50.6%，K56-1x从15.8%升至37.0%，而K56-2x从63.2%降至12.3%。中位无进展生存期分别为：K56-1x组13.0个月[95%置信区间（CI）11.2-20.7]，K56-2x组13.2个月（95% CI 9.0-28.1），K70-1x组10.9个月（95% CI 9.9-15.3）；这些差异无统计学意义（对数秩检验p=0.46）。心力衰竭发生率在各组间相当（均低于5%）。总之，我们的研究结果不支持在RRMM中采用每周两次卡非佐米方案能改善预后。K56-1x方案可能在疗效、安全性及避免频繁输注的时间毒性之间达到最佳平衡。
肿瘤(癌症)患者之家