Carfilzomib

Last updated
Carfilzomib
Carfilzomib structure.svg
Clinical data
Trade names Kyprolis
Other namesPX-171-007
AHFS/Drugs.com Monograph
MedlinePlus a612031
License data
Pregnancy
category
  • AU:C
Routes of
administration 		Intravenous
ATC code
Legal status
Legal status
Pharmacokinetic data
Protein binding 97% [2]
Metabolism Extensive; CYP plays a minor role
Identifiers
  • (2S)-4-Methyl-N-[(2S)-1-[[(2S)-4-methyl-1-[(2R)-2-methyloxiran-2-yl]-1-oxopentan-2-yl]amino]-1-oxo-3-phenylpropan-2-yl]-2-[[(2S)-2-[(2-morpholin-4-ylacetyl)amino]-4-phenylbutanoyl]amino]pentanamide
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
CompTox Dashboard (EPA)
ECHA InfoCard 100.219.957 OOjs UI icon edit-ltr-progressive.svg
Chemical and physical data
Formula C40H57N5O7
Molar mass 719.924 g·mol−1
3D model (JSmol)
  • O=C(N[C@H](C(=O)N[C@H](C(=O)N[C@H](C(=O)N[C@H](C(=O)[C@@]1(OC1)C)CC(C)C)Cc2ccccc2)CC(C)C)CCc3ccccc3)CN4CCOCC4
  • InChI=1S/C40H57N5O7/c1-27(2)22-32(36(47)40(5)26-52-40)42-39(50)34(24-30-14-10-7-11-15-30)44-38(49)33(23-28(3)4)43-37(48)31(17-16-29-12-8-6-9-13-29)41-35(46)25-45-18-20-51-21-19-45/h6-15,27-28,31-34H,16-26H2,1-5H3,(H,41,46)(H,42,50)(H,43,48)(H,44,49)/t31-,32-,33-,34-,40+/m0/s1
  • Key:BLMPQMFVWMYDKT-NZTKNTHTSA-N

Carfilzomib, sold under the brand name Kyprolis, is an anti-cancer medication acting as a selective proteasome inhibitor. Chemically, it is a tetrapeptide epoxyketone and an analog of epoxomicin. [3] It was developed by Onyx Pharmaceuticals.

Contents

The US Food and Drug Administration (FDA) approved it in July 2012. [4] [5]

Medical uses

The FDA approved carfilzomib in July 2012, for use in people with multiple myeloma who have received at least two prior therapies, including treatment with bortezomib and an immunomodulatory therapy (such as lenalidomide) and have demonstrated disease progression on or within 60 days of completion of the last therapy. [4]

Mechanism

Carfilzomib covalently [6] irreversibly binds to and inhibits the chymotrypsin-like activity of the 20S proteasome, an enzyme that degrades unwanted cellular proteins. Carfilzomib displays minimal interactions with non-proteasomal targets, thereby improving safety profiles over bortezomib. [6] Inhibition of proteasome-mediated proteolysis results in a build-up of polyubiquitinated proteins, which may cause cell cycle arrest, apoptosis, and inhibition of tumor growth. [3]

History

Carfilzomib is derived from epoxomicin, a natural product that was shown by the laboratory of Craig Crews at Yale University to inhibit the proteasome. [7] The Crews laboratory subsequently invented a more specific derivative of epoxomicin named YU101, [8] which was licensed to Proteolix, Inc. Scientists at Proteolix invented a new, distinct compound that had potential use as a drug in humans, known as carfilzomib. Proteolix advanced carfilzomib to multiple phase I and II clinical trials, including a pivotal phase 2 clinical trial designed to seek accelerated approval. [9] Clinical trials for carfilzomib continue under Onyx Pharmaceuticals, which acquired Proteolix in 2009. [9]

In January 2011, the FDA granted carfilzomib fast-track status, allowing Onyx to initiate a rolling submission of its new drug application for carfilzomib. [10] In December 2011, the FDA granted Onyx standard review designation, [11] [12] for its new drug application submission based on the 003-A1 study, an open-label, single-arm phase IIb trial. The trial evaluated 266 heavily-pretreated patients with relapsed and refractory multiple myeloma who had received at least two prior therapies, including bortezomib and either thalidomide or lenalidomide. [13]

Initial approval was based on response rate. [4] Data demonstrating an overall survival benefit was demonstrated in the ENDEAVOR trial and approved by the FDA. [14]

Clinical trials & side effects

Completed

A single-arm, phase II trial (003-A1) of carfilzomib in patients with relapsed and refractory multiple myeloma showed that single-agent carfilzomib demonstrated a clinical benefit rate of 36% in the 266 patients evaluated and had an overall response rate of 22.9% and median duration of response of 7.8 months. The FDA approval of carfilzomib was based on results of the 003-A1 trial. [2]

In a phase II trial (004), carfilzomib had a 53% overall response rate among patients with relapsed and/or refractory multiple myeloma who had not previously received bortezomib. This study also included a bortezomib-treated cohort. Results were reported separately. [15] This study also found prolonged carfilzomib treatment was tolerable, with approximately 22% of patients continuing treatment beyond one year. The 004 trial was a smaller study originally designed to investigate the impact of carfilzomib treatment in relationship to bortezomib treatment in less heavily pretreated (1–3 prior regimens) patients. [16]

A phase II trial (005), which assessed the safety, pharmacokinetics, pharmacodynamics and efficacy of carfilzomib, in patients with multiple myeloma and varying degrees of renal impairment, where nearly 50% of patients were refractory to both bortezomib and lenalidomide, demonstrated that pharmacokinetics and safety were not influenced by the degree of baseline renal impairment. Carfilzomib was tolerable and demonstrated efficacy. [17]

In another phase II trial (006) of patients with relapsed and/or refractory multiple myeloma, carfilzomib in combination with lenalidomide and dexamethasone demonstrated an overall response rate of 69%. [18]

A phase II trial (007) for multiple myeloma and solid tumors showed promising results. [19] [20]

In phase II trials of carfilzomib, the most common grade 3 or higher treatment-emergent adverse events were hematologic toxicity [21] with thrombocytopenia, anemia, lymphopenia, neutropenia, pneumonia, fatigue and hyponatremia. [22]

In a frontline phase I/II study, the combination of carfilzomib, lenalidomide, and low-dose dexamethasone was highly active and well tolerated, permitting the use of full doses for an extended time in newly diagnosed multiple myeloma patients, with limited need for dose modification. Responses were rapid and improved over time, reaching 100% very good partial response. [23]

Furthermore, gastrointestinal disturbances, including diarrhea and nausea are non hematologic group of side effects commonly reported with proteasome inhibitors. [21] Additionally, cardiovascular toxicity may be an outcome of carfilzomib treatment due to the effects on proteasomes in the myocardium. [21] Thus, patient evaluation and risk assessment prior to initiation of therapy with carfilzomib is crucial. [24]

ASPIRE trial

A phase III confirmatory clinical trial, known as the ASPIRE trial, compared carfilzomib, lenalidomide, and dexamethasone (KRd) versus lenalidomide and dexamethasone (Rd) in patients with relapsed multiple myeloma and found improved progression-free survival and overall survival. Treatment discontinuation because of adverse effects occurred less frequently in the KRd arm, and events included thrombocytopenia, hypertension, and heart failure. [25] [26]

Society and culture

Economics

Carfilzomib costs approximately US$10,000 per 28-day cycle. [27]

Related Research Articles

<span class="mw-page-title-main">Multiple myeloma</span> Cancer of plasma cells

Multiple myeloma (MM), also known as plasma cell myeloma and simply myeloma, is a cancer of plasma cells, a type of white blood cell that normally produces antibodies. Often, no symptoms are noticed initially. As it progresses, bone pain, anemia, kidney dysfunction, and infections may occur. Complications may include hypercalcemia and amyloidosis.

<span class="mw-page-title-main">Lenalidomide</span> Pair of enantiomers

Lenalidomide, sold under the brand name Revlimid among others, is a medication used to treat multiple myeloma, smoldering myeloma, and myelodysplastic syndromes (MDS). For multiple myeloma, it is used after at least one other treatment and generally with dexamethasone. It is taken by mouth.

<span class="mw-page-title-main">Bortezomib</span> Chemical compound

Bortezomib, sold under the brand name Velcade among others, is an anti-cancer medication used to treat multiple myeloma and mantle cell lymphoma. This includes multiple myeloma in those who have and have not previously received treatment. It is generally used together with other medications. It is given by injection.

<span class="mw-page-title-main">Proteasome inhibitor</span>

Proteasome inhibitors are drugs that block the action of proteasomes, cellular complexes that break down proteins. They are being studied in the treatment of cancer; three are approved for use in treating multiple myeloma.

<span class="mw-page-title-main">Plitidepsin</span> Chemical compound

Plitidepsin is a chemical compound extracted from the ascidian Aplidium albicans. It is currently undergoing clinical trial testing. It is a member of the class of compounds known as didemnins.

Elotuzumab, sold under the brand name Empliciti, is a humanized IgG1 monoclonal antibody medication used in combination with lenalidomide and dexamethasone, for adults that have received 1 to 3 prior therapies for the treatment of multiple myeloma. It is also indicated for adult patients in combination with pomalidomide and dexamethasone, who have received 2 prior therapies including lenalidomide and a protease inhibitor. Administration of elotuzumab is done intravenously. Each intravenous injection of elotuzumab should be premedicated with dexamethasone, diphenhydramine, ranitidine and acetaminophen. It is being developed by Bristol Myers Squibb and AbbVie.

<span class="mw-page-title-main">Panobinostat</span> Chemical compound

Panobinostat, sold under the brand name Farydak, is a medication used for the treatment of multiple myeloma. It is a hydroxamic acid and acts as a non-selective histone deacetylase inhibitor.

<span class="mw-page-title-main">Pomalidomide</span> Chemical compound

Pomalidomide, sold under the brand names Pomalyst and Imnovid, is an anti-cancer medication used for the treatment of multiple myeloma and AIDS-related Kaposi sarcoma.

<span class="mw-page-title-main">Perifosine</span> Chemical compound

Perifosine is a former drug candidate that was under development for a variety of cancer indications. It is an alkyl-phospholipid structurally related to miltefosine. Perifosine interrupts the PI3K/AKT/mTOR pathway by acting as an allosteric AKT inhibitor targeting the pleckstrin homology domain of AKT. It was being developed by Keryx Biopharmaceuticals who had licensed it from Æterna Zentaris Inc.

<span class="mw-page-title-main">Daratumumab</span> Monoclonal antibody

Daratumumab, sold under the brand name Darzalex, is an anti-cancer monoclonal antibody medication. It binds to CD38, which is overexpressed in multiple myeloma cells. Daratumumab was originally developed by Genmab, but it is now being jointly developed by Genmab along with the Johnson & Johnson subsidiary Janssen Biotech, which acquired worldwide commercialization rights to the drug from Genmab.

Onyx Pharmaceuticals Inc. has been a biopharmaceutical company headquartered in South San Francisco, California. The company developed and marketed medicines for the treatment of cancer. Onyx was founded in 1992 by Kevin J. Kinsella and Frank McCormick Ph.D., FRS. McCormick served as the chief scientific officer until 1998, while Kinsella was the firm's chairman. In 2009, the company acquired Proteolix, Inc., a private biotechnology company, for $276 million in cash plus additional milestone payments. In January 2012, the company was named "the top biotechnology takeover target in 2012" through an industry survey. Onyx president and chief executive officer (CEO) Tony Coles had said that Onyx liked its prospects as an independent company and was focused on bringing new therapies to patients. However, at the end of August 2013, Amgen announced it was acquiring Onyx in an agreed $10.4 billion deal.

<span class="mw-page-title-main">Filanesib</span> Chemical compound

Filanesib is a kinesin spindle protein (KIF11) inhibitor which has recently been proposed as a cancer treatment, specifically for multiple myeloma.

<span class="mw-page-title-main">Isatuximab</span> Monoclonal antibody

Isatuximab, sold under the brand name Sarclisa, is a monoclonal antibody (mAb) medication for the treatment of multiple myeloma.

<span class="mw-page-title-main">Ixazomib</span> Chemical compound

Ixazomib is a drug for the treatment of multiple myeloma, a type of white blood cell cancer, in combination with other drugs. It is taken by mouth in the form of capsules.

<span class="mw-page-title-main">Melphalan flufenamide</span> Chemical compound

Melphalan flufenamide, sold under the brand names Pepaxto and Pepaxti, is an anticancer medication used to treat multiple myeloma.

<span class="mw-page-title-main">Oprozomib</span> Chemical compound

Oprozomib is an orally active second-generation proteasome inhibitor developed by Proteolix, which was acquired by Onyx Pharmaceuticals, an Amgen subsidiary, in 2009. It selectively inhibits chymotrypsin-like activity of both the constitutive proteasome (PSMB5) and immunoproteasome (LMP7).

Craig M. Crews is an American scientist at Yale University known for his contributions to chemical biology. He is known for his contributions to the field of induced proximity through his work in creating heterobifunctional molecules that hijack cellular processes by inducing the interaction of two proteins inside a living cell. His initial work focused on the discovery of PROteolysis-TArgeting Chimeras (PROTACs) to trigger degradation of disease-causing proteins, a process known as targeted protein degradation (TPD), and he has since developed new versions of -TACs to leverage other cellular processes and protein families to treat disease.

<span class="mw-page-title-main">Selinexor</span> Anti-cancer drug

Selinexor sold under the brand name Xpovio among others, is a selective inhibitor of nuclear export used as an anti-cancer medication. It works by blocking the action of exportin 1 and thus blocking the transport of several proteins involved in cancer-cell growth from the cell nucleus to the cytoplasm, which ultimately arrests the cell cycle and leads to apoptosis. It is the first drug with this mechanism of action.

Daratumumab/hyaluronidase, sold under the brand name Darzalex Faspro, is a fixed-dose combination medication for the treatment of adults with newly diagnosed or relapsed/refractory multiple myeloma. It is a combination of daratumumab and hyaluronidase. It is administered via subcutaneous injection.

Belantamab mafodotin, sold under the brand name Blenrep, is a medication for the treatment of relapsed and refractory multiple myeloma.

References

  1. ↑ "Prescription medicines: registration of new chemical entities in Australia, 2016". Therapeutic Goods Administration (TGA). 21 June 2022. Retrieved 10 April 2023.
  2. 1 2 3 "Kyprolis- carfilzomib injection, powder, lyophilized, for solution". DailyMed. 26 August 2020. Retrieved 13 November 2020.
  3. 1 2 "NCI Drug Dictionary". National Cancer Institute. Retrieved 13 November 2020.
  4. 1 2 3 "FDA Approves Kyprolis for Some Patients with Multiple Myeloma". FDA. 2012-07-20. Archived from the original on 2013-01-28. Retrieved 2013-07-23.
  5. ↑ "Drug Approval Package: Kyprolis (carfilzomib) for Injection NDA #202714". U.S. Food and Drug Administration (FDA). 20 August 2012. Retrieved 10 April 2023.
  6. 1 2 Park JE, Park J, Jun Y, Oh Y, Ryoo G, Jeong YS, et al. (May 2019). "Expanding therapeutic utility of carfilzomib for breast cancer therapy by novel albumin-coated nanocrystal formulation". Journal of Controlled Release. 302: 148–159. doi:10.1016/j.jconrel.2019.04.006. PMC   6638563 . PMID   30954620.
  7. ↑ Meng L, Mohan R, Kwok BH, Elofsson M, Sin N, Crews CM (August 1999). "Epoxomicin, a potent and selective proteasome inhibitor, exhibits in vivo antiinflammatory activity". Proceedings of the National Academy of Sciences of the United States of America. 96 (18): 10403–8. Bibcode:1999PNAS...9610403M. doi: 10.1073/pnas.96.18.10403 . PMC   17900 . PMID   10468620.
  8. ↑ Myung J, Kim KB, Lindsten K, Dantuma NP, Crews CM (February 2001). "Lack of proteasome active site allostery as revealed by subunit-specific inhibitors". Molecular Cell. 7 (2): 411–20. doi: 10.1016/S1097-2765(01)00188-5 . PMID   11239469.
  9. 1 2 "Carfilzomib: From Discovery To Drug". Chemical & Engineering News. 2012-08-27. Retrieved 2013-07-30.
  10. ↑ "Onyx multiple myeloma drug wins FDA fast-track status". San Francisco Business Times. 2011-01-31. Retrieved 2011-09-01.
  11. ↑ "Beacon Breaking News – Carfilzomib to Get Standard, Not Priority, FDA Review". The Myeloma Beacon. Retrieved 2012-02-27.
  12. ↑ "Fast Track, Accelerated Approval and Priority Review; Accelerating Availability of New Drugs for Patients with Serious Diseases". FDA. Archived from the original on 2012-02-17. Retrieved 2012-02-27.
  13. ↑ "PX-171-003-A1, an open-label, single-arm, phase (Ph) II study of carfilzomib (CFZ) in patients (pts) with relapsed and refractory multiple myeloma (R/R MM): Long-term follow-up and subgroup analysis". ASCO 2011; Abstract 8027. 2011. Archived from the original on 2012-03-23. Retrieved 2011-09-01.
  14. ↑ Broderick JM (18 January 2018). "FDA Approves Carfilzomib Label Update in Myeloma". OncLive. Retrieved 10 April 2023.
  15. ↑ Vij R, Siegel DS, Jagannath S, Jakubowiak AJ, Stewart AK, McDonagh K, et al. (September 2012). "An open-label, single-arm, phase 2 study of single-agent carfilzomib in patients with relapsed and/or refractory multiple myeloma who have been previously treated with bortezomib". British Journal of Haematology. 158 (6): 739–48. doi:10.1111/j.1365-2141.2012.09232.x. PMC   5818209 . PMID   22845873.
  16. ↑ Vij R, Wang M, Kaufman JL, Lonial S, Jakubowiak AJ, Stewart AK, et al. (June 2012). "An open-label, single-arm, phase 2 (PX-171-004) study of single-agent carfilzomib in bortezomib-naive patients with relapsed and/or refractory multiple myeloma". Blood. 119 (24): 5661–70. doi:10.1182/blood-2012-03-414359. PMC   4123327 . PMID   22555973.
  17. ↑ Badros AZ, Vij R, Martin T, Zonder JA, Kunkel L, Wang Z, et al. (August 2013). "Carfilzomib in multiple myeloma patients with renal impairment: pharmacokinetics and safety". Leukemia. 27 (8): 1707–14. doi:10.1038/leu.2013.29. PMC   3740399 . PMID   23364621.
  18. ↑ "European Hematology Association (EHA) 18th Congress. June 13-16, 2013". The Myeloma Beacon. 2013. Retrieved 2013-07-13.
  19. ↑ "Nikoletta Lendval, MD PhD et al. Phase II Study of Infusional Carfilzomib in Patients with Relapsed or Refractory Multiple Myeloma". Presented at: 54th ASH Annual Meeting and Exposition: December 2012. Retrieved 2013-07-23.
  20. ↑ "Phase II results of Study PX-171-007: A phase Ib/II study of carfilzomib (CFZ), a selective proteasome inhibitor, in patients with selected advanced metastatic solid tumors" - ASCO 2009; Abstract 3515.
  21. 1 2 3 Guerrero-Garcia TA, Gandolfi S, Laubach JP, Hideshima T, Chauhan D, Mitsiades C, et al. (December 2018). "The power of proteasome inhibition in multiple myeloma". Expert Review of Proteomics. 15 (12): 1033–1052. doi:10.1080/14789450.2018.1543595. PMID   30427223. S2CID   53303519.
  22. ↑ Siegel DS, Martin T, Wang M, et al. (2011-03-09). "Results of PX-171- 003-A1, an open-label, single-arm, phase 2 study of carfilzomib in patients with relapsed and refractory multiple myeloma. Presented at: 52nd ASH Annual Meeting and Exposition; December 4-7, 2010; Orlando, Florida". December 2010. OncLive.com. Retrieved 2011-09-01.
  23. ↑ "Final Results of a Frontline Phase 1/2 Study of Carfilzomib Lenalidomide, and Low-Dose Dexamethasone (CRd) in Multiple Myeloma (MM)". ASH 20111; Abstract 631. Retrieved 2012-02-27.
  24. ↑ Efentakis P, Kremastiotis G, Varela A, Nikolaou PE, Papanagnou ED, Davos CH, et al. (February 2019). "Molecular mechanisms of carfilzomib-induced cardiotoxicity in mice and the emerging cardioprotective role of metformin". Blood. 133 (7): 710–723. doi: 10.1182/blood-2018-06-858415 . PMID   30482794.
  25. ↑ "Phase 3 Study Comparing Carfilzomib, Lenalidomide, and Dexamethasone (CRd) Versus Lenalidomide and Dexamethasone (Rd) in Subjects With Relapsed Multiple Myeloma". ClinicalTrials.gov. 2011-08-04. Retrieved 2011-09-01.
  26. ↑ Stenger, Matthew (January 31, 2018). "ASPIRE Trial: Final Overall Survival Results in Relapsed or Refractory Multiple Myeloma". The ASCO Post. Retrieved March 28, 2021.
  27. ↑ "FDA Approves Kyprolis (Carfilzomib) For Relapsed And Refractory Multiple Myeloma". The Myeloma Beacon. Retrieved 2012-07-20.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.