Carfilzomib, pomalidomide, and dexamethasone for multiple myeloma after carfilzomib, lenalidomide, and dexamethasone.

Carfilzomib, lenalidomide, and dexamethasone (KRD) regimens are widely used for relapsed/refractory multiple myeloma (RRMM). However, their administration is limited to 18 cycles, and many patients relapse during subsequent lenalidomide/dexamethasone (Rd) maintenance. As pomalidomide may overcome lenalidomide refractoriness, a phase II study was conducted to evaluate the efficacy and safety of carfilzomib, pomalidomide, and dexamethasone (KPD) in patients previously treated with KRD. Eligible patients received at least 12 cycles of KRD and six cycles of Rd, were aged 20-80 years, and had measurable disease. The KPD regimen consisted of 56 mg/m2 carfilzomib (days 1, 8, and 15), pomalidomide 4 mg (days 1-21), and weekly dexamethasone 40 mg, repeated every 28 days. The primary endpoint was the overall response rate (ORR). Between October 2021 and September 2023, 12 patients (median age 60 years, 67% male) were enrolled. The ORR was 75%, including three complete, four very good partial, and two partial responses. The median progression-free survival was 17.2 months. Grade ≥ 3 hematologic toxicities included neutropenia (75%), thrombocytopenia (50%), and anemia (33%). The study was terminated early because of slow accruals. KPD appears to be feasible for lenalidomide-refractory carfilzomib-sensitive RRMM.