Oncology Ny
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Patients with multiple myeloma (MM) frequently experience renal dysfunction owing to patient-specific risk factors, the pathophysiology of MM, and treatment-related adverse events. The presence of renal complications in patients with MM may be associated with advanced disease and is a negative prognostic factor for survival. Frequently these patients receive reduced or modified dosing regimens, which can result in under-dosing and may adversely affect treatment efficacy. ⋯ Carfilzomib is a selective proteasome inhibitor approved in the United States as a single agent for the treatment of relapsed and refractory MM. Safety studies have demonstrated that single-agent carfilzomib is well tolerated in patients with relapsed and/or refractory MM and concomitant renal dysfunction. This article reviews the etiology and incidence of renal adverse events in patients with MM, the renal safety profile of single-agent carfilzomib from four phase II studies in patients with relapsed and/or refractory MM, and the management of patients with MM who receive carfilzomib and are at risk for renal complications.
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Hematologic adverse events (AEs) are commonly encountered in patients with multiple myeloma (MM) owing to the nature of the disease and the adverse effects related to myeloma treatment. Immunomodulatory drugs (eg, thalidomide, lenalidomide, and pomalidomide) and the proteasome inhibitor bortezomib have all been associated with increased rates of anemia, neutropenia, and thrombocytopenia, as well as greater incidences of infection caused by associated immunosuppression. The proteasome inhibitor carfilzomib was recently approved in the United States for the treatment of patients with relapsed and refractory MM. This article reviews the hematologic safety profile of carfilzomib in patients with relapsed/refractory MM, as assessed in a cross-trial safety analysis of four phase II studies, and makes recommendations for the appropriate management of hematologic AEs.
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Peripheral neuropathy (PN) is frequently seen in patients with multiple myeloma (MM) and commonly arises as a consequence of the disease itself and as an adverse effect of anti-MM treatment. Treatment-induced PN may occur in up to 75% of patients receiving anti-MM treatment (particularly in those receiving a thalidomide- or bortezomib-based regimen), and its occurrence often leads to dose reductions or treatment discontinuation, which may ultimately affect response to therapy. ⋯ This article reviews the etiology and incidence of PN with current novel anti-myeloma therapies and includes clinical trial data with respect to PN in 526 patients treated with carfilzomib for relapsed and/or refractory MM. The use of carfilzomib in patients with a history of PN and the incidence of new-onset PN in carfilzomib-treated patients are considered, and a clinical perspective on the management of PN in these patients is provided.