Real-World Use of carfilzomib-lenalidomide-dexamethasone (KRd) and carfilzomib-dexamethasone (Kd) in Relapsed/Refractory Multiple Myeloma in the Asia Pacific Region: A Prospective Multicenter Observational Study

Background: Carfilzomib has demonstrated enhanced efficacy and tolerability in head-to-head clinical trials in patients with relapsed/refractory multiple myeloma (RRMM). However, real-world data on its use and outcomes in the Asia Pacific region remains limited. Methods: This prospective, observational, real-world study included 300 RRMM patients from 29 sites in the Asia Pacific region, who received carfilzomib between July 2019 and June 2023. Data was collected from medical records every 3 months to assess safety and efficacy of two approved regimens: carfilzomib with lenalidomide and dexamethasone (KRd) and carfilzomib with dexamethasone alone (Kd). Results: In KRd cohort, mean age was 62.7 years and median prior lines of therapy (LOT) was 1; in Kd cohort, mean age was 66.3 years with a median LOT of 3 (38% ≥ 4 LOTs). KRd achieved an overall response rate (ORR) of 81.7%, including 53.6% complete responses (CR) and 73.3% very good partial responses (VGPR). In the Kd cohort, ORR was 54.5%, with 27.2% CR and 34.8% VGPR. Median overall survival (OS) was 60.9 months with KRd and 41.6 with Kd; median time to progression (TTP) was 38.5 and 23.7 months, respectively. Grade ≥ 3 adverse events occurred in 18.8% (KRd) and 30.7% (Kd); treatment-related events occurred in 4.0% and 8.8%, leading to discontinuations in 1.1% and 2.6%, respectively. Conclusion: Carfilzomib administered as either KRd or Kd was effective and well tolerated, even in patients with multiple prior LOTs, confirming the safety and response rates observed from clinical trials and real-world studies.