Summary

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• This summary is based on the review of 17 systematic review(s)/meta-analysis(es). ^[1-17]
• Proteasome inhibitors, including carfilzomib, significantly improved progression-free survival (PFS) and overall survival (OS) in multiple myeloma (MM) maintenance therapy, with bortezomib exhibiting superior OS over carfilzomib.
• In newly diagnosed multiple myeloma (NDMM), carfilzomib/lenalidomide/dexamethasone (KRd) showed higher complete response rates and measurable residual disease negativity compared to bortezomib/lenalidomide/dexamethasone (VRd), with improved PFS in high-risk cytogenetic patients.
• Carfilzomib-based regimens demonstrated superior objective response rates (ORRs) over bortezomib-based treatments in relapsed/refractory multiple myeloma (RRMM), ranking highly among RRMM therapies and showing favorable safety.
• For lenalidomide-refractory MM, carfilzomib/dexamethasone provided better outcomes compared to bortezomib/dexamethasone, especially in maintaining efficacy in high-risk cytogenetic profiles.
• Carfilzomib was associated with adverse effects, including peripheral neuropathy, serious adverse events, rash, vomiting, hematological toxicity, and notably high-grade cardiovascular toxicity, such as hypertension, heart failure, edema, and ischemia, with a similar incidence of cardiotoxicity observed in both newly diagnosed and relapsed/refractory patients.
• Carfilzomib showed a significant risk of kidney toxicity, with an observed cumulative rate of 21.3% for all-grade kidney toxicity and 8.3% for grades 3-5 kidney toxicities.
• Compared to bortezomib, carfilzomib had a lower incidence of neuropathy but presented higher cumulative and relative risks of kidney toxicity and higher rates of cardiovascular toxicity.
• Carfilzomib-based therapies demonstrated significant efficacy in improving progression-free survival (PFS) and overall survival (OS) in patients with high-risk cytogenetics, lenalidomide-refractory MM, NDMM, and RRMM, particularly within subpopulations benefiting from triplet therapies and regimens combining monoclonal antibodies, with favorable response rates and safety profiles.