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Systemic Anti-Cancer Therapy Regimen Library

Home > PCN MM Relapsed - carfilzomib and dexamethasone [Q1W]

PCN MM Relapsed - carfilzomib and dexamethasone [Q1W]

Treatment Overview

Cycle 1 - 28 days

Cycle length:
28

Cycles 2 to 9 - 28 days

Cycle length:
28

Carfilzomib dose: For cycle 2 and further cycles, consider increasing carfilzomib dose to 70 mg/m2 (cap dose at: 154 mg) IV days 1, 8 and 15, according to response and if tolerated.

Cycle 10 (and all further cycles) - 28 days

Cycle length:
28

Carfilzomib dose: For cycle 2 and further cycles, consider increasing carfilzomib dose to 70 mg/m2 (cap dose at: 154 mg) IV days 1, 8 and 15, according to response and if tolerated.

Cycle details

Cycle 1 - 28 days

Medication Dose Route Days Max Duration
dexamethasone * 40 mg flat dosing oral administration 1, 8, 15,
22
sodium chloride 0.9 % intravenous 1, 8, 15 30 minutes
carfilzomib * 20 mg/m² Cap dose per administration at: 44 mg intravenous 1 30 minutes
carfilzomib * 56 mg/m² Cap dose per administration at: 123 mg intravenous 8, 15 30 minutes

Cycles 2 to 9 - 28 days

Medication Dose Route Days Max Duration
dexamethasone * 40 mg flat dosing oral administration 1, 8, 15,
22
carfilzomib * 56 mg/m² Cap dose per administration at: 123 mg intravenous 1, 8, 15 30 minutes

Carfilzomib dose: For cycle 2 and further cycles, consider increasing carfilzomib dose to 70 mg/m2 (cap dose at: 154 mg) IV days 1, 8 and 15, according to response and if tolerated.

Cycle 10 (and all further cycles) - 28 days

Medication Dose Route Days Max Duration
dexamethasone * 40 mg flat dosing oral administration 1, 8, 15
carfilzomib * 56 mg/m² Cap dose per administration at: 123 mg intravenous 1, 8, 15 30 minutes

Carfilzomib dose: For cycle 2 and further cycles, consider increasing carfilzomib dose to 70 mg/m2 (cap dose at: 154 mg) IV days 1, 8 and 15, according to response and if tolerated.

Full details

Cycle 1 - 28 days

Day: 1

Medication Dose Route Max duration Details
dexamethasone * 40 mg flat dosing oral administration
Instructions:

30 minutes to 4 hours prior to carfilzomib with food.
sodium chloride 0.9 % intravenous 30 minutes
Quantity:250 mL
Instructions:

Prior to carfilzomib infusion. Centres may choose to increase to 500 ml or omit this bag of fluid if not required or for clinical reasons.
carfilzomib * 20 mg/m² Cap dose per administration at: 44 mg intravenous 30 minutes

Day: 8

Medication Dose Route Max duration Details
dexamethasone * 40 mg flat dosing oral administration
Instructions:

30 minutes to 4 hours prior to carfilzomib with food.
sodium chloride 0.9 % intravenous 30 minutes
Quantity:250 mL
Instructions:

Prior to carfilzomib infusion. Centres may choose to increase to 500 ml or omit this bag of fluid if not required or for clinical reasons.
carfilzomib * 56 mg/m² Cap dose per administration at: 123 mg intravenous 30 minutes

Day: 15

Medication Dose Route Max duration Details
dexamethasone * 40 mg flat dosing oral administration
Instructions:

30 minutes to 4 hours prior to carfilzomib with food.
sodium chloride 0.9 % intravenous 30 minutes
Quantity:250 mL
Instructions:

Prior to carfilzomib infusion. Centres may choose to increase to 500 ml or omit this bag of fluid if not required or for clinical reasons.
carfilzomib * 56 mg/m² Cap dose per administration at: 123 mg intravenous 30 minutes

Day: 22

Medication Dose Route Max duration Details
dexamethasone * 40 mg flat dosing oral administration
Instructions:
Take in the morning with food.

Cycles 2 to 9 - 28 days

Day: 1

Medication Dose Route Max duration Details
dexamethasone * 40 mg flat dosing oral administration
Instructions:

30 minutes to 4 hours prior to carfilzomib with food.
carfilzomib * 56 mg/m² Cap dose per administration at: 123 mg intravenous 30 minutes
Instructions:

Consider increasing dose to 70 mg/m2 (cap dose at: 154 mg) according to response and if tolerated.

Day: 8

Medication Dose Route Max duration Details
dexamethasone * 40 mg flat dosing oral administration
Instructions:

30 minutes to 4 hours prior to carfilzomib with food.
carfilzomib * 56 mg/m² Cap dose per administration at: 123 mg intravenous 30 minutes
Instructions:

Consider increasing dose to 70 mg/m2 (cap dose at: 154 mg) according to response and if tolerated.

Day: 15

Medication Dose Route Max duration Details
dexamethasone * 40 mg flat dosing oral administration
Instructions:

30 minutes to 4 hours prior to carfilzomib with food.
carfilzomib * 56 mg/m² Cap dose per administration at: 123 mg intravenous 30 minutes
Instructions:

Consider increasing dose to 70 mg/m2 (cap dose at: 154 mg) according to response and if tolerated.

Day: 22

Medication Dose Route Max duration Details
dexamethasone * 40 mg flat dosing oral administration
Instructions:
Take in the morning with food.

Cycle 10 (and all further cycles) - 28 days

Day: 1

Medication Dose Route Max duration Details
dexamethasone * 40 mg flat dosing oral administration
Instructions:

30 minutes to 4 hours prior to carfilzomib with food.
carfilzomib * 56 mg/m² Cap dose per administration at: 123 mg intravenous 30 minutes
Instructions:

Consider increasing dose to 70 mg/m2 (cap dose at: 154 mg) according to response and if tolerated.

Day: 8

Medication Dose Route Max duration Details
dexamethasone * 40 mg flat dosing oral administration
Instructions:

30 minutes to 4 hours prior to carfilzomib with food.
carfilzomib * 56 mg/m² Cap dose per administration at: 123 mg intravenous 30 minutes
Instructions:

Consider increasing dose to 70 mg/m2 (cap dose at: 154 mg) according to response and if tolerated.

Day: 15

Medication Dose Route Max duration Details
dexamethasone * 40 mg flat dosing oral administration
Instructions:

30 minutes to 4 hours prior to carfilzomib with food.
carfilzomib * 56 mg/m² Cap dose per administration at: 123 mg intravenous 30 minutes
Instructions:

Consider increasing dose to 70 mg/m2 (cap dose at: 154 mg) according to response and if tolerated.

Supportive Care Factors

Factor Value
Antiviral prophylaxis for herpes virus: Routine antiviral prophylaxis recommended
Emetogenicity: Low
Gastroprotection: Gastroprotection may be considered
Hydration: Variable
Hypersensitivity / Infusion related reaction risk: High - routine premedication recommended
Pneumocystis jirovecii pneumonia (PJP) prophylaxis: Routine antibiotic prophylaxis recommended
Thromboprophylaxis: Thromboprophylaxis may be considered
Tumour lysis syndrome prophylaxis: Tumour lysis syndrome prophylaxis may be considered

Antiviral prophylaxis for hepatitis B virus: Guidance is limited to high-risk anti-cancer medicines. Clinicians will need to assess individual patient risk for other anti-cancer medicines.


References

Quach, H., D. White, A. Spencer, et al. 2017. "Pharmacokinetics and safety of carfilzomib in patients with relapsed multiple myeloma and end-stage renal disease (ESRD): an open-label, single-arm, phase I study." Cancer Chemother Pharmacol 79(6):1067-1076. , PMID: 28424963

Moreau, P., M.V. Mateos, J.R. Berenson, et al. 2018. "Once weekly versus twice weekly carfilzomib dosing in patients with relapsed and refractory multiple myeloma (A.R.R.O.W.): interim analysis results of a randomised, phase 3 study." Lancet Oncol 19(7):953-964., PMID: 29866475

Dimopoulos, M. A., P. Moreau, A. Palumbo, et al. 2016. "Carfilzomib and dexamethasone versus bortezomib and dexamethasone for patients with relapsed or refractory multiple myeloma (ENDEAVOR): a randomised, phase 3, open-label, multicentre study." Lancet Oncol 17(1):27-38., PMID: 26671818

Moreau, P., K.A. Stewart, M. Dimopoulos, et al. 2020. "Once-weekly (70 mg/m2) vs twice-weekly (56 mg/m2) dosing of carfilzomib in patients with relapsed or refractory multiple myeloma: A post hoc analysis of the ENDEAVOR, A.R.R.O.W., and CHAMPION-1 trials." Cancer Med 9(9):2989-2996. , PMID: 32108443

Bringhen, S., A. Milan, M. D'Agostino et al. 2019. "Prevention, monitoring and treatment of cardiovascular adverse events in myeloma patients receiving carfilzomib. A consensus paper by the European Myeloma Network and the Italian Society of Arterial Hypertension". J Intern Med 2019; 286: 63-74., PMID: 30725503

Amgen (New Zealand) Limited Kyprolis New Zealand Datasheet 4 December 2020 https://www.medsafe.govt.nz/profs/datasheet/k/kyprolisinf.pdf (Accessed 31 March 2022).

Regimen details sometimes vary slightly from the published literature after recommendation by expert committee consensus.

* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.

s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.