Introduction

Carfilzomib (trade name: Kyprolis) has been approved in Germany since November 2015 for the treatment of multiple myeloma. The drug is an option for adults who have already had treatment at least once. It is combined with the drugs lenalidomide and dexamethasone, or with dexamethasone alone.

Multiple myeloma is a rare type of cancer in which mutated plasma cells multiply uncontrollably in the bone marrow. This causes bone tissue to be destroyed and prevents normal blood formation, resulting in bone pain and bone fractures, as well as anemia. Multiple myeloma also weakens the immune system and is life-threatening.

This new drug is supposed to stop the cancer cells from dividing and spreading.

Application

Carfilzomib is given as an infusion (drip) in combination with dexamethasone and lenalidomide, or with dexamethasone alone, in 28-day cycles. In the first three weeks of each cycle, the patients are given an infusion twice a week on two consecutive days. They then have a 12-day break from treatment. Each infusion usually lasts 10 to 30 minutes. The treatment is stopped if the disease still progresses or if very severe side effects arise.

Other treatments

The standard treatments for people with multiple myeloma who have already been treated are:

  • bortezomib combined with doxorubicin
  • bortezomib combined with dexamethasone
  • lenalidomide combined with dexamethasone or
  • elotuzumab combined with lenalidomide and dexamethasone

Assessment

In 2017, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) looked into whether carfilzomib has any advantages or disadvantages for people with multiple myeloma when compared with the current standard treatments.

The manufacturer provided one suitable study for assessment, involving 792 patients who had been treated previously. Half of them were given carfilzomib, lenalidomide and dexamethasone, while the other half had the standard treatment of lenalidomide and dexamethasone. The manufacturer did not submit any usable data for the comparison of the standard treatment with carfilzomib plus dexamethasone.

What are the advantages of carfilzomib?

  • Life expectancy: The study suggests that carfilzomib has an advantage here for people under the age of 65: Half of the patients in this age group who had treatment with lenalidomide plus dexamethasone had already died after about 3 years and 2 months. Half of the patients who received carfilzomib had passed away after about 4 years and 6 months. So, on average, life expectancy increased by almost one and a half years in people who used carfilzomib. The study did not find any difference between the treatments in people older than 65.

No difference

  • Treatment stopped due to side effects: There was no difference between the treatments here. In each treatment group, about 20 out of 100 people stopped the therapy due to side effects.

What remains unanswered?

  • The manufacturer did not provide any suitable data on the following:
    • Symptoms of the disease
    • Quality of life
    • Severe side effects

More information

This information summarizes the main results of a review produced by the Institute for Quality and Efficiency in Health Care (IQWiG, Germany). The review was commissioned by the German Federal Joint Committee (G-BA) as part of the “early benefit assessment of medications.” On the basis of the review and the hearings received, the G-BA passed a resolution on the added benefit of carfilzomib (Kyprolis).