Real-World Utilization of Carfilzomib (Once or Twice Weekly) Initiated in Patients After a First Relapse Between 2017 and 2022 in France: An Analysis From a Large-Scale Epidemiology of Multiple MYeloma (EmmY) Cohort

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PURPOSE: Carfilzomib (K) is approved in France to treat multiple myeloma in second line or later (2L+) with dexamethasone (Kd), lenalidomide and dexamethasone (KRd), daratumumab and dexamethasone (D-Kd). We assessed K utilization and outcomes in a French real-world cohort (2017-2022). RESULTS: Overall, 972 patients-initiated K treatment in 2L (21%), 3L (23%) and 4L+ (56%). Patients were largely exposed (96%) and refractory (75%) to immunomodulatory drugs. The most frequent regimens in 2L were KRd (33%) and D-Kd (24%), in 3L were Kd (27%) and K with pomalidomide and dexamethasone (KPd; 27%) and in 4L+ was Kd (49%). Of the 224 elderly patients (≥ 75 years), 45% received Kd in 4L+. Since 2018, KRd and Kd use declined in favor of D-Kd and KPd. The recommended K dose was mostly used despite some variability. In 2022, once-weekly dosing was used in most D-Kd and KRd patients, and half of Kd and KPd patients. Effectiveness of K-based regimens was similar regardless of starting K once-weekly and twice-weekly. Overall response rate (ORR) for KRd in 2L was 81%, with median overall survival (mOS) not reached (NR). ORR for D-Kd was 76% (78% in 2L) and mOS 32.0 months (NR in 2L). For KPd, ORR was 69% with mOS of 26.4 months. For Kd, ORR was 54% in 4L, 51% among elderly patients, and mOS was 15.5 months. CONCLUSIONS: This real-world study confirms carfilzomib effectiveness at both dosing frequencies. K triplets resulted in long survivals and Kd remained satisfactory to treat heavily pretreated patients.

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