Results By Patient Type

These data have been compiled to provide an overview of efficacy with respect to one or more characteristics that may apply to this patient type, and certain data may also apply to other patient types represented herein.

These data were compiled from post hoc analyses of the KRd vs Rd and Kd vs Vd studies to provide a categorical overview of efficacy by patient type. The four defined patient types are based on one or more characteristics that may be used to differentiate your patients with relapsed or refractory multiple myeloma.

FIT with a
STANDARD RISK

FIT with a
HIGH RISK

FRAIL with a
STANDARD RISK

FRAIL with a
HIGH RISK

FIT with a
STANDARD RISK

FIT with a
HIGH RISK

FRAIL with a
STANDARD RISK

FRAIL with a
HIGH RISK

High Risk^1,2

Defined as relapse within 12 months from transplant or progression within the first year of diagnosis, high cytogenetic risk (from FISH) with chromosomal abnormalities (ie, t(4;14), t(14;16), t(14;20), del(17p), 1q gain), R-ISS stage III, high-risk gene expression profiling, and/or high PC S-phase.

Standard Risk^1,2

Defined as cytogenetic abnormalities that are not considered high risk (trisomies, t(11;14), t(6;14)), and/or R-ISS stage I.

Fit^3,4,*

Defined as a person < 75 years of age, ECOG Performance Status 0-1, no or well-controlled comorbidities, adequate renal and hepatic function, and/or no significant cardiovascular risk factors.

Frail^3,4,*

Defined as a person ≥ 75 years of age, ECOG Performance Status of 2 or more, wheelchair bound, having comorbidities (including diabetes or congestive heart failure), renal impairment, and/or hepatic impairment.

*Having 1 or 2 of these characteristics does not necessarily categorize a patient as fit, nor frail.

The IMWG has proposed a frailty score that utilizes an additive scoring system based on age, comorbidities, and cognitive and physical conditions.

KYPROLIS^®-based regimens (KRd and Kd) demonstrated superior median progression-free survival vs Rd and Vd, respectively^5,^†,‡

^†KRd27 as a triplet therapy

8.7-month increase in median PFS: 26.3 months (KRd) vs 17.6 months (Rd); hazard ratio (KRd/Rd) = 0.69 (95% CI: 0.57-0.83); two-sided P = 0.0001⁵

^‡Kd56 as a doublet therapy

9.3-month increase in median PFS: 18.7 months (Kd) vs 9.4 months (Vd); hazard ratio (Kd/Vd) = 0.53 (95% CI: 0.44-0.65); one-sided P < 0.0001⁵

CI = confidence interval; ECOG = Eastern Cooperative Oncology Group; FISH = fluorescence in situ hybridization; IMWG = International Myeloma Working Group; ISS = International Staging System; Kd = KYPROLIS^® (carfilzomib) and dexamethasone; KRd = KYPROLIS^® (carfilzomib), lenalidomide, and dexamethasone; PC = plasma cell; Rd = lenalidomide and dexamethasone; R-ISS = Revised International Staging System; Vd = VELCADE^® (bortezomib) and dexamethasone.

Analyses by patient characteristic: high-risk/fit

High-risk/fit patient description^§

This is a patient who is likely to have high cytogenetic risk (as determined by FISH sequencing)
Additionally, this patient may be young (< 75 years of age), or older with good physical function (ECOG Performance Status 0-1), and normal renal and hepatic function

High-risk Early relapse during prior therapy < 70 years of age Prior stem cell transplant Prior bortezomib exposure

PFS and ≥ CR⁶

PFS

High-risk/fit patient (KRd): 9.2-month increase in progression-free survival

≥ CR

5x the ≥ CR rate for KRd vs Rd alone:
29.2% vs 5.8%

Prespecified Subgroup Analysis of KRd (n = 48) vs Rd (n = 52)

In the clinical study, high risk consisted of patients with genetic subtypes: t(4;14), t(14;16), or del(17p).

Data included were the subject of a prespecified or post hoc subgroup analysis of the KRd vs Rd trial; however, the efficacy in these subgroups was not a study objective and the study was not powered to assess efficacy in these subgroups.

^§These data have been compiled to provide an overview of efficacy with respect to one or more characteristics that may apply to this patient type, and certain data may also apply to other patient types represented herein.

≥ CR = complete response or better; ECOG = Eastern Cooperative Oncology Group; FISH = fluorescence in situ hybridization; KRd = KYPROLIS^® (carfilzomib), lenalidomide, and dexamethasone; ORR = overall response rate; PFS = progression-free survival; Rd = lenalidomide and dexamethasone.

PFS, ORR, and Rate of ≥ CR⁷

PFS

High-risk/fit patient with early relapse during prior therapy (KRd): increase of nearly 11 months in progression-free survival

ORR

83.2% KRd vs 54.8% Rd

≥ CR

Almost 3x the ≥ CR rate for KRd vs Rd alone:
22.1% vs 7.7%

Post Hoc Analysis of KRd (n = 113) vs Rd (n = 104)

PFS and ORR⁸

PFS

High-risk/fit patient aged < 70 years (KRd): increase of 11 months in progression-free survival

ORR

86.0% KRd vs 66.9% Rd

Post Hoc Analysis of KRd (n = 293) vs Rd (n = 281)

PFS and ORR⁹

PFS

High-risk/fit patient with prior stem cell transplant (KRd): increase of nearly 9 months in progression-free survival

ORR

90.3% KRd vs 65.5% Rd

Post Hoc Analysis of KRd (n = 217) vs Rd (n = 229)

PFS¹⁰

High-risk/fit patient with prior bortezomib exposure (KRd): increase of nearly 8 months in progression-free survival

Post Hoc Analysis of KRd (n = 261) vs Rd (n = 260)

Analyses by patient characteristic: standard-risk/fit

Standard-risk/fit patient description**

This is a patient who most likely does not have high cytogenetic risk (determined by FISH) or high tumor burden at the time of relapse
Additionally, this patient may be young (< 75 years of age), or older with good physical function (ECOG Performance Status 0-1), ISS I, and normal renal and hepatic function

Standard-risk < 70 years of age At first relapse Prior stem cell transplant Prior bortezomib exposure

PFS and ≥ CR⁶

PFS

Standard-risk/fit patient (KRd): increase of more than 10 months in progression-free survival

≥ CR

Nearly 6x the ≥ CR rate for KRd vs Rd alone: 38.1% vs 6.5%

Prespecified Subgroup Analysis of KRd (n = 147) vs Rd (n = 170)

In the clinical study, the standard-risk group consisted of patients with known baseline cytogenetics that did not include t(4;14), t(14;16), or del(17p).

**These data have been compiled to provide an overview of efficacy with respect to one or more characteristics that may apply to this patient type, and certain data may also apply to other patient types represented herein.

≥ CR = complete response or better; ECOG = Eastern Cooperative Oncology Group; FISH = fluorescence in situ hybridization; ISS = International Staging System; KRd = KYPROLIS^® (carfilzomib), lenalidomide, and dexamethasone; ORR = overall response rate; PFS = progression-free survival; Rd = lenalidomide and dexamethasone.

PFS and ORR⁸

PFS

Standard-risk/fit patient aged < 70 years (KRd): increase of 11 months in progression-free survival

ORR

86.0% KRd vs 66.9% Rd

Post Hoc Analysis of KRd (n = 293) vs Rd (n = 281)

PFS and ≥ CR¹⁰

PFS

Standard-risk/fit patient at first relapse (KRd): increase of 12 months in progression-free survival

≥ CR

Nearly 5x the ≥ CR rate for KRd vs Rd alone: 33.7% vs 7.0%

Prespecified Subgroup Analysis (1 Prior Therapy) of KRd (n = 184) vs Rd (n = 157)

PFS and ORR⁹

PFS

Standard-risk/fit patient with prior stem cell transplant (KRd): increase of nearly 9 months in progression-free survival

ORR

90.3% KRd vs 65.5% Rd

Post Hoc Analysis of KRd (n = 217) vs Rd (n = 229)

PFS¹⁰

Standard-risk/fit patient with prior bortezomib exposure (KRd): increase of nearly 8 months in progression-free survival

Post Hoc Analysis of KRd (n = 261) vs Rd (n = 260)

Analyses by patient characteristic: high-risk/frail

High-risk/frail patient description^††

This is a patient who is likely to have high cytogenetic risk (as determined by FISH sequencing)
Additionally, this patient may be older (≥ 75), ECOG of at least 2, R-ISS II or III, renally impaired, hepatically impaired, wheelchair bound, and have comorbidities such as diabetes

High-risk Early relapse during prior therapy ≥ 70 years of age Prior stem cell transplant

PFS and ≥ CR⁶

PFS

High-risk/frail patient (KRd): 9.2-month increase in progression-free survival

≥ CR

5x the ≥ CR rate for KRd vs Rd alone: 29.2% vs 5.8%

Prespecified Subgroup Analysis of KRd (n = 48) vs Rd (n = 52)

In the clinical study, high risk consisted of patients with genetic subtypes: t(4;14), t(14;16), or del(17p).

Data included were the subject of a prespecified or post hoc subgroup analysis of the KRd vs Rd and/or Kd vs Vd trials; however, the efficacy in these subgroups was not a study objective and the studies were not powered to assess efficacy in these subgroups.

^††These data have been compiled to provide an overview of efficacy with respect to one or more characteristics that may apply to this patient type, and certain data may also apply to other patient types represented herein.

CI = confidence interval; ≥ CR = complete response or better; CrCL = creatinine clearance; ECOG = Eastern Cooperative Oncology Group; FISH = fluorescence in situ hybridization; HR = hazard ratio; Kd = KYPROLIS^® (carfilzomib) and dexamethasone; KRd = KYPROLIS^® (carfilzomib), lenalidomide, and dexamethasone; ORR = overall response rate; OS = overall survival; PFS = progression-free survival; Rd = lenalidomide and dexamethasone; R-ISS = Revised International Staging System; Vd = VELCADE^® (bortezomib) and dexamethasone.

PFS, ORR, and ≥ CR⁷

PFS

High-risk/frail patient with early relapse during prior therapy (KRd): increase of nearly 11 months in progression-free survival

ORR

83.2% KRd vs 54.8% Rd

≥ CR

Almost 3x the ≥ CR rate for KRd vs Rd alone: 22.1% vs 7.7%

Post Hoc Analysis of KRd (n = 113) vs Rd (n = 104)

PFS and ORR⁸

PFS

High-risk/frail patient aged ≥ 70 (KRd): increase of nearly 8 months in progression-free survival

ORR

90.3% KRd vs 66.1% Rd

Post Hoc Analysis of KRd (n = 103) vs Rd (n = 115)

PFS and ORR⁹

PFS

High-risk/frail patient with prior stem cell transplant (KRd): increase of nearly 9 months in progression-free survival

ORR

90.3% KRd vs 65.5% Rd

Post Hoc Analysis of KRd (n = 217) vs Rd (n = 229)

High-risk Early relapse during prior therapy Renal function: CrCL ≥ 15 to < 80 mL/min Renal function: CrCL ≥ 80 mL/min At first relapse Prior stem cell transplant Prior bortezomib exposure Prior lenalidomide exposure < 65 years of age 65-74 years of age ≥ 75 years of age

PFS, ORR, and ≥ CR¹¹

PFS

High-risk/frail patient (Kd): increase of nearly 3 months in progression-free survival

Nearly 3-month increase in median PFS for del(17p) patients on Kd vs Vd: 7.6 months vs 4.9 months (Kd n = 40; Vd n = 52)
Over 3-month increase in median PFS for t(4;14) patients on Kd vs Vd: 10.1 months vs 6.8 months (Kd n = 50; Vd n = 61)

ORR

72.2% Kd vs 58.4% Vd

≥ CR

Over 3x the ≥ CR rate for Kd vs Vd alone: 15.5% vs 4.4%

Prespecified Subgroup Analysis of Kd (n = 97) vs Vd (n = 113)

In the clinical study, high risk consisted of patients with the genetic subtype t(4;14) or t(14;16) in ≥ 10% of screened plasma cells or with del(17p) in ≥ 20% of screened plasma cells.

PFS⁷

High-risk/frail patient with early relapse during prior therapy (Kd): increase of over 8 months in progression-free survival

Post Hoc Analysis of Kd (n = 123) vs Vd (n = 116)

PFS, OS, ORR, and ≥ CR¹²

PFS

High-risk/frail patient with renal function ≥15 to < 50 mL/min (Kd): increase of 8.4 in median PFS; High-risk/frail patient with renal function 50 to < 80 mL/min (Kd): increase of 9.2 in median PFS

High-risk/frail patient with renal function ≥15 to < 50 mL/min (Kd): increase of 16.6 in median OS; High-risk/frail patient with renal function 50 to < 80 mL/min (Kd): median OS was not reached

ORR

CrCL ≥ 15 to < 50 mL/min: 74.1% Kd vs 49.5% Vd
CrCL 50 to < 80 mL/min: 78.5% Kd vs 69.5% Vd

≥ CR

CrCL ≥ 15 to < 50 mL/min: 8.2% Kd vs 4.0% Vd
CrCL 50 to < 80 mL/min: 9.1% Kd vs 7.3% Vd

Post Hoc Analysis

CrCL ≥ 15 to < 50 mL/min: Kd (n = 85) vs Vd (n = 99)
CrCL 50 to < 80 mL/min: Kd (n = 186) vs Vd (n = 177)

PFS, OS, ORR, and ≥ CR¹²

PFS

High-risk/frail patient with renal function ≥ 80 mL/min (Kd): increase of 5.4 months in median OS. Median PFS was not reached

ORR

CrCL ≥ 80 mL/min: 76.7% Kd vs 63.0% Vd

≥ CR

CrCL ≥ 80 mL/min: 17.6% Kd vs 6.3% Vd

Post Hoc Analysis

CrCL ≥ 80 mL/min: Kd (n = 193) vs Vd (n = 189)

PFS and ORR¹³

PFS

High-risk/frail patient at first relapse (Kd): increase of over 12 months in progression-free survival

ORR

81.9% Kd vs 65.5% Vd

Prespecified Subgroup Analysis (1 Prior Therapy) of Kd (n = 232) vs Vd (n = 232)

Reduced risk in disease progression or death and ORR⁹

Reduced risk for progression or death

High-risk/frail patient with prior stem cell transplant (Kd): 39% reduced risk in disease progression or death

(HR = 0.61; 95% CI: 0.47-0.79)
Median PFS has not been reached for Kd vs
10.2 months for Vd

ORR

73.3% Kd vs 66.9% Vd

Post Hoc Analysis of Kd (n = 266) vs Vd (n = 272)

PFS and ORR¹³

PFS

High-risk/frail patient with prior bortezomib exposure at first relapse (Kd): increase of over 7 months in progression-free survival

10-month increase in median PFS at first relapse for Kd vs Vd: 18.7 months vs 8.7 months

ORR AT FIRST RELAPSE

78.4% Kd vs 64.3% Vd
Prior bortezomib at first relapse: Kd (n = 97) vs Vd (n = 98)

Prespecified Subgroup Analysis of Kd (n = 250) vs Vd (n = 252)

PFS and ORR at first relapse¹³

PFS

High-risk/frail patient with prior lenalidomide exposure at first relapse (Kd): increase of over 5 months in progression-free survival

ORR AT FIRST RELAPSE

82.4% Kd vs 64.4% Vd
Prior exposure to lenalidomide at first relapse: Kd (n = 51) vs Vd (n = 45)

Prespecified Subgroup Analysis of Kd (n = 177) vs Vd (n = 177)

PFS, OS, and ORR^14,15

PFS

High-risk/frail patient aged < 65 years (Kd): progression-free survival

OS¹⁵

Nearly 6-month increase in median OS for Kd vs Vd: 47.6 months vs 41.9 months

ORR¹⁴

74.0% Kd vs 61.0% Vd

Post Hoc Analysis of Kd (n = 223) vs Vd (n = 210)

PFS, OS, and ORR^14,15

PFS

High-risk/frail patient aged 65-74 (Kd): increase of over 6 months in progression-free survival

OS¹⁵

Median OS: Not reached for Kd vs 37.0 months for Vd

ORR¹⁴

77.4% Kd vs 65.6% Vd

Post Hoc Analysis of Kd (n = 164) vs Vd (n = 189)

PFS, OS, and ORR^14,15

PFS

High-risk/frail patient aged ≥ 75 (Kd): increase of nearly 10 months in progression-free survival

OS¹⁵

Over 16-month increase in median OS for Kd vs Vd: 42.4 months vs 25.9 months

ORR¹⁴

84.4% Kd vs 59.1% Vd

Post Hoc Analysis of Kd (n = 77) vs Vd (n = 66)

Analyses by patient characteristic: standard-risk/frail

Standard-risk/frail patient description^‡‡

This is a patient who most likely does not have high cytogenetic risk (determined by FISH) or high tumor burden at the time of relapse
Additionally, this patient may be older (≥ 75), ECOG 2 or more, R-ISS I, renally impaired, hepatically impaired, wheelchair bound, and have comorbidities such as diabetes

Standard-risk At first relapse Prior bortezomib exposure Prior lenalidomide exposure < 65 years of age 65-74 years of age ≥ 75 years of age

PFS, ORR, and ≥ CR¹¹

PFS

Standard-risk/frail patient (Kd): progression-free survival

ORR

79.2% Kd vs 66.0% Vd

≥ CR

13.0% Kd vs 7.9% Vd

Prespecified Subgroup Analysis of Kd (n = 284) vs Vd (n = 291)

In the clinical study, the standard-risk group consisted of patients with known baseline cytogenetics that did not include t(4;14), t(14;16), or del(17p).

Data included on these pages were the subject of a prespecified or post hoc subgroup analysis of the Kd vs Vd trial; however, the efficacy in these subgroups was not a study objective and the study was not powered to assess efficacy in these subgroups.

^‡‡These data have been compiled to provide an overview of efficacy with respect to one or more characteristics that may apply to this patient type, and certain data may also apply to other patient types represented herein.

≥ CR = complete response or better; Kd = KYPROLIS^® (carfilzomib) and dexamethasone; ECOG = Eastern Cooperative Oncology Group; FISH = fluorescence in situ hybridization; ORR = overall response rate; OS = overall survival; PFS = progression-free survival; R-ISS = Revised International Staging System; Vd = VELCADE^® (bortezomib) and dexamethasone.

PFS and ORR¹³

PFS

Standard-risk/frail patient at first relapse (Kd): increase of over 12 months in progression-free survival

ORR

81.9% Kd vs 65.5% Vd

Prespecified Subgroup Analysis (1 Prior Therapy) of Kd (n = 232) vs Vd (n = 232)

PFS and ORR¹³

PFS

Standard-risk/frail patient with prior bortezomib exposure (Kd): increase of over 7 months in progression-free survival

10-month increase in median PFS at first relapse for Kd vs Vd: 18.7 months vs 8.7 months

ORR AT FIRST RELAPSE

78.4% Kd vs 64.3% Vd
Prior bortezomib at first relapse: Kd (n = 97) vs Vd (n = 98)

Prespecified Subgroup Analysis of Kd (n = 250) vs Vd (n = 252)

PFS and ORR at first relapse¹³

PFS

Standard-risk/frail patient with prior lenalidomide exposure (Kd): increase of over 5 months in progression-free survival

ORR AT FIRST RELAPSE

82.4% Kd vs 64.4% Vd
Prior exposure to lenalidomide at first relapse:
Kd (n = 51) vs Vd (n = 45)

Prespecified Subgroup Analysis of Kd (n = 177) vs Vd (n = 177)

PFS, OS, and ORR^14,15

PFS

Standard-risk/frail patient aged < 65 years (Kd): progression-free survival

OS¹⁵

Nearly 6-month increase in median OS for Kd vs Vd: 47.6 months vs 41.9 months

ORR¹⁴

74.0% Kd vs 61.0% Vd

Post Hoc Analysis of Kd (n = 223) vs Vd (n = 210)

PFS, OS, and ORR^14,15

PFS

Standard-risk/frail patient aged 65-74 years (Kd): increase of over 6 months in progression-free survival

OS¹⁵

Not reached for Kd vs 37.0 months for Vd

ORR¹⁴

77.4% Kd vs 65.6% Vd

Post Hoc Analysis of Kd (n = 164) vs Vd (n = 189)

PFS, OS, and ORR^14,15

PFS

Standard-risk/frail patient aged ≥ 75 (Kd): increase of nearly 10 months in progression-free survival

OS¹⁵

Over 16-month increase in median OS for Kd vs Vd: 42.4 months vs 25.9 months

ORR¹⁴

84.4% Kd vs 59.1% Vd

Post Hoc Analysis of Kd (n = 77) vs Vd (n = 66)

See mechanism of action

Next Kd once weekly safety

KRd vs Rd study: A phase 3, randomized, open-label, multicenter superiority study evaluated KYPROLIS^® in combination with lenalidomide and dexamethasone (KRd) vs lenalidomide and dexamethasone (Rd) in patients with relapsed or refractory multiple myeloma who had received 1 to 3 prior lines of therapy. 792 patients were randomized in a 1:1 ratio (396 patients to KRd, 396 to Rd). Patients received their randomized study treatment in 28-day cycles until disease progression or unacceptable toxicity occurred. KYPROLIS^® was discontinued after Cycle 18. The primary endpoint was progression-free survival (PFS); select secondary endpoints included overall survival (OS), overall response rate (ORR), duration of response (DoR), and safety.^5,16,17

Kd vs Vd study: A phase 3, randomized, open-label, multicenter superiority study compared KYPROLIS^® plus dexamethasone (Kd) to VELCADE^® plus dexamethasone (Vd) in patients with relapsed or refractory multiple myeloma who had received 1 to 3 lines of therapy. 929 patients were randomized to a 1:1 ratio to receive Kd (n = 464) for 28-day cycles or Vd (n = 465) for 21-day cycles until disease progression or unacceptable toxicity occurred. The primary endpoint was progression-free survival (PFS). Select secondary endpoints included overall survival (OS), overall response rate (ORR), duration of response (DoR), and safety.^5,18

REFERENCES

1. The mSMART Clinical Practice Guidelines in relapsed myeloma. Mayo Stratification for Myeloma and Risk-adapted Therapy website. https://nebula.wsimg.com/1c0adc8316c5947bb2b948ad5e9e2e55?AccessKeyId=A0994494BBBCBE4A0363&disposition=0&alloworigin=1. 2. Palumbo A, Avet-Loiseau H, Oliva S, et al. Revised International Staging System for multiple myeloma: a report from International Myeloma Working Group. J Clin Oncol. 2015;33:2863-2869. 3. Palumbo A, Bringhen S, Mateos M-V, et al. Geriatric assessment predicts survival and toxicities in elderly myeloma patients: an International Myeloma Working Group report. Blood. 2015;125:2068-2074. 4. Oken MM, Creech RH, Tormey DC, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5:649-655. 5. KYPROLIS^® (carfilzomib) prescribing information, Onyx Pharmaceuticals Inc., an Amgen Inc. subsidiary. 6. Avet-Loiseau H, Fonseca R, Siegel D, et al. Carfilzomib significantly improves the progression-free survival of high-risk patients in multiple myeloma. Blood. 2016;128:1174-1180. 7. Mateos M-V, Goldschmidt H, San-Miguel J, et al. Carfilzomib in relapsed or refractory multiple myeloma patients with early or late relapse following prior therapy: a subgroup analysis of randomized phase 3 ASPIRE and ENDEAVOR trials. Hematol Oncol. 2018;36:463-470. 8. Dimopoulos MA, Stewart AK, Masszi T, et al. Carfilzomib, lenalidomide, and dexamethasone in patients with relapsed multiple myeloma categorized by age: secondary analysis from the phase 3 ASPIRE study. Br J Haematol. 2017;177:404-413. 9. Hari P, Mateos M-V, Abonour R, et al. Efficacy and safety of carfilzomib regimens in multiple myeloma patients relapsing after autologous stem cell transplant: ASPIRE and ENDEAVOR outcomes. Leukemia. 2017;31:2630-2641. 10. Dimopoulos MA, Stewart AK, Masszi T, et al. Carfilzomib-lenalidomide-dexamethasone vs lenalidomide-dexamethasone in relapsed multiple myeloma by previous treatment. Blood Cancer J. 2017;7:e554. 11. Chng WJ, Goldschmidt H, Dimopoulos MA, et al. Carfilzomib-dexamethasone vs bortezomib-dexamethasone in relapsed or refractory multiple myeloma by cytogenetic risk in the phase 3 study ENDEAVOR. Leukemia. 2017;31:1368-1374. 12. Dimopoulos MA, Siegel D, White DJ, et al. Superior efficacy of carfilzomib and dexamethasone (Kd56) vs bortezomib and dexamethasone (Vd) in multiple myeloma (MM) patients with moderate or serious renal failure: a subgroup analysis of the phase 3 ENDEAVOR study. Blood. 2017;130:1845. 13. Moreau P, Joshua D, Chng W-J, et al. Impact of prior treatment on patients with relapsed multiple myeloma treated with carfilzomib and dexamethasone vs bortezomib and dexamethasone in the phase 3 ENDEAVOR study. Leukemia. 2017;31:115-122. 14. Ludwig H, Dimopoulos MA, Moreau P, et al. Carfilzomib and dexamethasone vs bortezomib and dexamethasone in patients with relapsed multiple myeloma: results of the phase 3 study ENDEAVOR (NCT01568866) according to age subgroup. Leuk Lymphoma. 2017;58:2501-2504. 15. Niesvizky R, Ludwig H, Spencer A, et al. Overall survival of relapsed/refractory multiple myeloma patients treated with carfilzomib and dexamethasone vs bortezomib and dexamethasone: results from the phase 3 ENDEAVOR study according to age subgroup. Blood. 2017;130:1885. 16. Siegel DS, Dimopoulos MA, Ludwig H, et al. Improvement in overall survival with carfilzomib, lenalidomide, and dexamethasone in patients with relapsed or refractory multiple myeloma. J Clin Oncol. 2018;36:728-734. 17. Stewart AK, Rajkumar SV, Dimopoulos MA, et al. Carfilzomib, lenalidomide, and dexamethasone for relapsed multiple myeloma. N Engl J Med. 2015;372:142-152. 18. Dimopoulos MA, Goldschmidt H, Niesvizky R, et al. Carfilzomib or bortezomib in relapsed or refractory multiple myeloma (ENDEAVOR): an interim overall survival analysis of an open-label, randomised, phase 3 trial. Lancet Oncol. 2017;18:1327-1337. Defined as cytogenetic abnormalities that are not considered high risk (trisomies, t(11;14), t(6;14)), and/or R-ISS stage I.Defined as relapse within 12 months from transplant or progression within the first year of diagnosis, high cytogenetic risk (from FISH) with chromosomal abnormalities (ie, t(4;14), t(14;16), t(14;20), del(17p), 1q gain), R-ISS stage III, high-risk gene expression profiling, and/or high PC S-phase.Defined as a person < 75 years of age, ECOG Performance Status 0-1, no or well-controlled comorbidities, adequate renal and hepatic function, and/or no significant cardiovascular risk factors.Defined as a person ≥ 75 years of age, ECOG Performance Status of 2 or more, wheelchair bound, having comorbidities (including diabetes or congestive heart failure), renal impairment, and/or hepatic impairment.

IMPORTANT SAFETY INFORMATION FOR KYPROLIS

Cardiac Toxicities

New onset or worsening of pre-existing cardiac failure (e.g., congestive heart failure, pulmonary edema, decreased ejection fraction), restrictive cardiomyopathy, myocardial ischemia, and myocardial infarction including fatalities have occurred following administration of KYPROLIS. Some events occurred in patients with normal baseline ventricular function. Death due to cardiac arrest has occurred within one day of administration.
Monitor patients for signs or symptoms of cardiac failure or ischemia. Evaluate promptly if cardiac toxicity is suspected. Withhold KYPROLIS for Grade 3 or 4 cardiac adverse events until recovery, and consider whether to restart at 1 dose level reduction based on a benefit/risk assessment.
While adequate hydration is required prior to each dose in Cycle 1, monitor all patients for evidence of volume overload, especially patients at risk for cardiac failure. Adjust total fluid intake as clinically appropriate.
For patients ≥ 75 years, the risk of cardiac failure is increased. Patients with New York Heart Association Class III and IV heart failure, recent myocardial infarction, conduction abnormalities, angina, or arrhythmias may be at greater risk for cardiac complications and should have a comprehensive medical assessment prior to starting treatment with KYPROLIS and remain under close follow-up with fluid management.

Acute Renal Failure

Cases of acute renal failure, including some fatal renal failure events, and renal insufficiency adverse events (including renal failure) have occurred. Acute renal failure was reported more frequently in patients with advanced relapsed and refractory multiple myeloma who received KYPROLIS monotherapy. Monitor renal function with regular measurement of the serum creatinine and/or estimated creatinine clearance. Reduce or withhold dose as appropriate.

Tumor Lysis Syndrome

Cases of Tumor Lysis Syndrome (TLS), including fatal outcomes, have occurred. Patients with a high tumor burden should be considered at greater risk for TLS. Adequate hydration is required prior to each dose in Cycle 1, and in subsequent cycles as needed. Consider uric acid lowering drugs in patients at risk for TLS. Monitor for evidence of TLS during treatment and manage promptly, and withhold until resolved.

Pulmonary Toxicity

Acute Respiratory Distress Syndrome (ARDS), acute respiratory failure, and acute diffuse infiltrative pulmonary disease such as pneumonitis and interstitial lung disease have occurred. Some events have been fatal. In the event of drug-induced pulmonary toxicity, discontinue KYPROLIS.

Pulmonary Hypertension

Pulmonary arterial hypertension (PAH) was reported. Evaluate with cardiac imaging and/or other tests as indicated. Withhold KYPROLIS for PAH until resolved or returned to baseline and consider whether to restart based on a benefit/risk assessment.

Dyspnea

Dyspnea was reported in patients treated with KYPROLIS. Evaluate dyspnea to exclude cardiopulmonary conditions including cardiac failure and pulmonary syndromes. Stop KYPROLIS for Grade 3 or 4 dyspnea until resolved or returned to baseline. Consider whether to restart based on a benefit/risk assessment.

Hypertension

Hypertension, including hypertensive crisis and hypertensive emergency, has been observed, some fatal. Control hypertension prior to starting KYPROLIS. Monitor blood pressure regularly in all patients. If hypertension cannot be adequately controlled, withhold KYPROLIS and evaluate. Consider whether to restart based on a benefit/risk assessment.

Venous Thrombosis

Venous thromboembolic events (including deep venous thrombosis and pulmonary embolism) have been observed. Thromboprophylaxis is recommended for patients being treated with the combination of KYPROLIS with dexamethasone or with lenalidomide plus dexamethasone. The thromboprophylaxis regimen should be based on an assessment of the patient’s underlying risks.
Patients using hormonal contraception associated with a risk of thrombosis should consider an alternative method of effective contraception during treatment.

Infusion Reactions

Infusion reactions, including life-threatening reactions, have occurred. Symptoms include fever, chills, arthralgia, myalgia, facial flushing, facial edema, vomiting, weakness, shortness of breath, hypotension, syncope, chest tightness, or angina. These reactions can occur immediately following or up to 24 hours after administration. Premedicate with dexamethasone to reduce the incidence and severity of infusion reactions. Inform patients of the risk and of symptoms and seek immediate medical attention if they occur.

Hemorrhage

Fatal or serious cases of hemorrhage have been reported. Hemorrhagic events have included gastrointestinal, pulmonary, and intracranial hemorrhage and epistaxis. Promptly evaluate signs and symptoms of blood loss. Reduce or withhold dose as appropriate.

Thrombocytopenia

KYPROLIS causes thrombocytopenia with recovery to baseline platelet count usually by the start of the next cycle. Monitor platelet counts frequently during treatment. Reduce or withhold dose as appropriate.

Hepatic Toxicity and Hepatic Failure

Cases of hepatic failure, including fatal cases, have occurred. KYPROLIS can cause increased serum transaminases. Monitor liver enzymes regularly regardless of baseline values. Reduce or withhold dose as appropriate.

Thrombotic Microangiopathy

Cases of thrombotic microangiopathy, including thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS), including fatal outcome, have occurred. Monitor for signs and symptoms of TTP/HUS. Discontinue if diagnosis is suspected. If the diagnosis of TTP/HUS is excluded, KYPROLIS may be restarted. The safety of reinitiating KYPROLIS is not known.

Posterior Reversible Encephalopathy Syndrome (PRES)

Cases of PRES have occurred in patients receiving KYPROLIS. If PRES is suspected, discontinue and evaluate with appropriate imaging. The safety of reinitiating KYPROLIS is not known.

Increased Fatal and Serious Toxicities in Combination with Melphalan and Prednisone in Newly Diagnosed Transplant-ineligible Patients

In a clinical trial of transplant-ineligible patients with newly diagnosed multiple myeloma comparing KYPROLIS, melphalan, and prednisone (KMP) vs bortezomib, melphalan, and prednisone (VMP), a higher incidence of serious and fatal adverse events was observed in patients in the KMP arm. KMP is not indicated for transplant-ineligible patients with newly diagnosed multiple myeloma.

Embryo-fetal Toxicity

KYPROLIS can cause fetal harm when administered to a pregnant woman.
Females of reproductive potential should be advised to avoid becoming pregnant while being treated with KYPROLIS and for 6 months following the final dose. Males of reproductive potential should be advised to avoid fathering a child while being treated with KYPROLIS and for 3 months following the final dose. If this drug is used during pregnancy, or if pregnancy occurs while taking this drug, the patient should be apprised of the potential hazard to the fetus.

ADVERSE REACTIONS

The most common adverse reactions in the combination therapy trials: anemia, neutropenia, diarrhea, dyspnea, fatigue, thrombocytopenia, pyrexia, insomnia, muscle spasm, cough, upper respiratory tract infection, hypokalemia.
The most common adverse reactions in monotherapy trials: anemia, fatigue, thrombocytopenia, nausea, pyrexia, dyspnea, diarrhea, headache, cough, edema peripheral.

Please see full Prescribing Information.

INDICATIONS

KYPROLIS^® (carfilzomib) is indicated in combination with dexamethasone or with lenalidomide plus dexamethasone for the treatment of patients with relapsed or refractory multiple myeloma who have received one to three lines of therapy.
KYPROLIS^® is indicated as a single agent for the treatment of patients with relapsed or refractory multiple myeloma who have received one or more lines of therapy.

IMPORTANT SAFETY INFORMATION

Warning: Skin rash

RAS-Mutant mCRC

Low Electrolytes

Infusion Reactions

Kidney problems

Lung problems

Avoid sunlight

Eye problems

Do not take with Avastin®

Avoid pregnancy

Avoid breastfeeding

Pregnancy Surveillance Program

Most common side effects

Talk to your doctor

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