Abstract
Treatment of patients with relapsed and/or refractory multiple myeloma (RR MM) is challenging due to the heterogeneity of the disease, patient comorbidities, and side effects of individual treatments. Carfilzomib, a selective proteasome inhibitor that has shown safety and efficacy as a single agent in phase I and II trials, was recently approved by the US Food and Drug Administration for RR MM. The aim of this review is to summarize adverse events (AEs) in patients with MM treated with single-agent carfilzomib in phase II clinical studies and to provide insight into the prevention and management of these AEs from the perspective of the advanced practitioner (AP). Data from a cross-trial safety analysis describing the safety and tolerability of single-agent carfilzomib in 526 patients with RR MM who received carfilzomib in four phase II trials are summarized. Additional information is included based on AP clinical practice experience gained in the clinical trial setting. Guidelines are suggested to assist with patient management prior to carfilzomib treatment, including hydration and prophylactic medication, as well as the management of hematologic AEs, fatigue, and dyspnea during treatment. Infrequent but potentially serious AEs, including cardiac and renal complications, are also reviewed. Adverse events in varying frequencies occur in response to carfilzomib, but they can be managed with prophylaxis and routine care. Utilizing the clinical practice experience with carfilzomib presented here should help to maximize the efficacy of carfilzomib while minimizing AEs and potential discomfort in patients with late-stage MM.
