Non-interventional Study of Kyprolis® in Combination With Revlimid® and Dexamethasone or Dexamethasone Alone or in Combination With Darzalex® and Dexamethasone in Multiple Myeloma Patients (CARO)

A Non-interventional Study of Carfilzomib (Kyprolis®) in Combination With Lenalidomide (Revlimid®) and Dexamethasone or Carfilzomib in Combination With Dexamethasone Alone or Carfilzomib in Combination With Daratumumab (Darzalex®) and Dexamethasone in Patients With Multiple Myeloma Who Have Received at Least One Prior Therapy

The objective of this non-interventional study (NIS) is to evaluate patients' adherence and persistence to carfilzomib therapy in combination with lenalidomide and dexamethasone or in combination with dexamethasone alone or in combination with daratumumab and dexamethasone in adult patients with multiple myeloma (MM) who have received at least one prior therapy in a real-life setting.

Study Overview

• Status: Completed
• Conditions: Multiple Myeloma in Relapse
• Intervention / Treatment: Drug: Carfilzomib

Detailed Description

The dual combination of lenalidomide (Revlimid®) (R) and dexamethasone (d) (Rd) as well as the dual combination of bortezomib (Velcade®, V) and dexamethasone (Vd) are standard regimens to treat MM patients who have received at least one prior therapy. Recently published clinical data indicate that the next-generation proteasome inhibitor carfilzomib (Kyprolis®) (K) may substantially change the treatment paradigm for patients with relapsed or refractory MM (RRMM).1 Three pivotal trials were conducted leading to market authorization of carfilzomib in combination with lenalidomide and dexamethasone or in combination with dexamethasone alone or in combination with dexamethasone and daratumumab for the treatment of MM patients who have received at least one prior therapy.

ASPIRE, NCT010803912 To compare the efficacy and safety of carfilzomib in combination with Rd (KRd) with the dual combination therapy Rd, a randomized, multicenter, open-label phase III study was performed in patients with relapsed MM (RMM). After cycle 18, carfilzomib was discontinued in the KRd arm, but Rd administration was continued thereafter until disease progression. The trial met its primary endpoint progression-free survival (PFS) (Hazard Ratio (HR) for progression or death, 0.69; p=0.0001). Median PFS was 26.3 months with KRd treatment compared to 17.6 months with Rd treatment. The study further demonstrates that carfilzomib improves patients' overall survival (OS) rate at 24 months (KRd, 73.3% vs. Rd, 65.0%; HR for death, 0.79; p=0.04) and overall response rate (ORR) (KRd, 87.1% vs. Rd, 66.7%; p<0.001). Objective assessment of adverse events (AEs) and patient-reported outcomes (PRO) revealed that the benefit-risk ratio is favorable for the three-drug combination KRd.

ENDEAVOR, NCT015688663 To compare the efficacy and safety of the dual combination therapy Kd with the dual combination therapy Vd, a randomized, multicenter, open-label phase III study was performed in patients with RRMM. Patients in both arms received treatment until progression. Results of the preplanned interim analysis show, that the trial met its primary endpoint PFS (HR for progression or death, 0.53; p<0.0001). Median PFS was 18.7 months with Kd treatment compared to 9.4 months with Vd treatment. In addition, the Kd combination therapy demonstrated superiority over the Vd combination therapy for secondary objectives, like ORR (77% vs. 63%; p<0.0001) and median duration of response (DOR) (21.3 months vs. 10.4 months). OS data were not available at time of analysis. Despite higher rates for cardiac and renal failure as well as higher incidence of hypertension and dyspnea in the Kd arm, carfilzomib given as a 30 min infusion has an acceptable safety profile, particularly with respect to lower peripheral neuropathy events. The number of patients who had ≥ grade 2 peripheral neuropathy was significantly higher in the Vd group than in the Kd group (32% vs. 6%). In conclusion, data of the ENDEAVOR study demonstrate, that carfilzomib given in combination with dexamethasone has a favorable benefit-risk profile and provides an important new treatment option for patients with RRMM.

CANDOR, NCT031586884-7 To compare the efficacy and safety of carfilzomib in combination with dexamethasone and daratumumab (KdD) with the dual combination therapy Kd, a randomized, multicenter, open-label phase III study was performed in patients with RRMM. Patients in both arms received treatment until progression. The trial met its primary endpoint PFS (HR for progression or death, 0.59). Median PFS was 28.6 months in the KdD arm and 15.2 months with Kd treatment with a median follow-up time of 27.8 months and 27.0 months, respectively. Further, KdD treatment demonstrates improved response rates by providing deeper responses. ORR was 84% (with 29% complete response (CR) or better) for KdD treatment and 75% (with 10% CR or better) for Kd treatment (p=0.0080). The minimal residual disease (MRD) negative CR rate at 12 months is nearly 10-times higher with KdD (12.5%) compared to Kd (1.3%). Overall, the safety profile is consistent with the known safety profiles of each agent, with the exception of an imbalance in treatment-emergent fatal AEs, which might be partially explained by longer treatment exposure, age, and frailty status.

Up to now, no real-life data on patients' adherence, persistence, quality of life (QoL) and patterns of use, effectiveness and safety of the KRd,the Kd and the KdD regimen have been systematically collected and analyzed. Thus, after market approval of KRd, Kd and KdD as treatment for patients with MM who have received at least one prior therapy, the purpose of the CARO NIS is to evaluate patients' adherence, persistence and QoL as well as effectiveness and safety of both regimens in a real-life setting.

• Study Type: Observational
• Enrollment (Actual): 359

Contacts and Locations

Study Locations

• Germany
  • Frankfurt, Germany, 60389
    • Centrum fur Hamatologie und Onkologie Bethanien

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

Adult patients with multiple myeloma (MM) who have received at least one prior therapy

Description

Inclusion Criteria:

• Aged 18 years or older.
• Patients with MM who have received at least one prior therapy.
• Indication for treatment as assessed by the treating physician.
• Decision for second- or subsequent-line treatment with the combination therapy carfilzomib/ lenalidomide/ dexamethasone or carfilzomib/ dexamethasone or carfilzomib/ dexamethasone/ daratumumab
• Signed written informed consent.
• Criteria according to the current Summary of Product Characteristics (SmPC) for Kyprolis® (Carfilzomib)

Exclusion Criteria:

• Contraindications according to the current SmPC for Kyprolis® (Carfilzomib)

Study Plan

How is the study designed?

Design Details

• Observational Models: Case-Only
• Time Perspectives: Prospective

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Car/Len/Dex (KRd); Patients treated with carfilzomib, lenalidomide and dexamethasone dosage form, dosage, frequency and duration of treatment according to current SmPC	Drug: Carfilzomib; In accordance with SmPC.; Other Names: Kyprolis®
Car/Dex (Kd); Patients treated with carfilzomib and dexamethasone dosage form, dosage, frequency and duration of treatment according to current SmPC	Drug: Carfilzomib; In accordance with SmPC.; Other Names: Kyprolis®
Car/Dex/Dara (KdD); Patients treated with carfilzomib, dexamethasone and daratumumab dosage form, dosage, frequency and duration of treatment according to current SmPC	Drug: Carfilzomib; In accordance with SmPC.; Other Names: Kyprolis®

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patients' adherence and persistence to carfilzomib therapy	Patients' adherence and persistence to carfilzomib therapy	Duration of Carfilzomib therapy, up to 24 months after last patient in

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patients' adherence and persistence to lenalidomide, dexamethasone and daratumumab therapy	Patients' adherence and persistence to lenalidomide, dexamethasone and daratumumab therapy	Duration of Carfilzomib therapy, up to 24 months after last patient in

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Median Progression-free Survival (PFS)	Median Progression-free Survival (PFS)	up to 24 months after last patient in
Overall Survival (OS) rate at 24 months	Overall Survival (OS) rate at 24 months	24 months
Median Time to Response (TTR)	Median Time to Response (TTR)	up to 24 months after last patient in
Median Duration of Response (DOR)	Median Duration of Response (DOR)	up to 24 months after last patient in
Overall Response Rate (ORR)	ORR is defined as ≥ Very Good Partial Response (VGPR) + Partial Response (PR)	up to 24 months after last patient in
To assess safety and tolerability measured by adverse events as graded by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v.4.03	AE, SAE and ADR are documented in the eCRF and will be used for safety assessment.	Duration of Carfilzomib therapy (+ 30 days), up to 25 months after last patient in
To assess health-related QoL using the validated BOMET-QoL-10 questionnaire	QoL data will be collected at baseline, after 6, 12, 18, 24 months (during treatment) and at the end of Carfilzomib therapy	Baseline, 6, 12, 18, 24, End of Treatment (latest up to 24 months after last patient in)

Collaborators and Investigators

• Sponsor: iOMEDICO AG
• Collaborators: Amgen
• Investigators: Principal Investigator: Wolfgang Knauf, Professor, Centrum für Hämatologie und Onkologie Bethanien, Germany, 60389 Frankfurt a.M.

Publications and helpful links

General Publications

• Engelhardt M, Ihorst G, Singh M, Rieth A, Saba G, Pellan M, Lebioda A. Real-World Evaluation of Health-Related Quality of Life in Patients With Multiple Myeloma From Germany. Clin Lymphoma Myeloma Leuk. 2021 Feb;21(2):e160-e175. doi: 10.1016/j.clml.2020.10.002. Epub 2020 Oct 24.

Study record dates

Study Major Dates

• Study Start (Actual): October 25, 2016
• Primary Completion (Actual): April 26, 2025
• Study Completion (Actual): April 26, 2025

Study Registration Dates

• First Submitted: November 10, 2016
• First Submitted That Met QC Criteria: November 18, 2016
• First Posted (Estimated): November 22, 2016

Study Record Updates

• Last Update Posted (Estimated): November 25, 2025
• Last Update Submitted That Met QC Criteria: November 20, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Immune System Diseases; Neoplasms by Histologic Type; Neoplasms; Lymphoproliferative Disorders; Immunoproliferative Disorders; Hematologic Diseases; Hemorrhagic Disorders; Hemostatic Disorders; Paraproteinemias; Blood Protein Disorders; Multiple Myeloma; Neoplasms, Plasma Cell; carfilzomib
• Other Study ID Numbers: IOM-070337

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO