How long should I be infusing carfilzomib intravenously?

Clinical Pearls Podcasts published on August 14, 2017
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Carol Ann Huff, MD
Assistant Professor of Oncology and Medicine
Director, Myeloma Program
Sidney Kimmel Comprehensive Cancer Center
Johns Hopkins Hospital
Baltimore, Maryland
How long should I be infusing carfilzomib intravenously?

Hi, I am Dr. Carol Ann Huff. Over the next few minutes, I will discuss with you how to dose carfilzomib, and in particular, the infusion duration for carfilzomib in patients with multiple myeloma.

There are two different durations of infusion that are listed in the package insert for carfilzomib. Mainly, when carfilzomib is given in conjunction with dexamethasone, the initial dosing for patients is 20 mg/m2, days 1 and 2 of the first cycle. This then escalates to 56 mg/m2 for all subsequent doses, beginning with day 8 of cycle 1. The schedule for carfilzomib is days 1-2, 8-9, and 15-16 every 28 days. In this regimen, all doses of carfilzomib are infused over a 30-minute duration.

Carfilzomib in Conjunction with Lenalidomide and Dexamethasone

  • Dose of carfilzomib also begins at 20 mg/m2 on the same schedule; days 1 and 2 of the first week
  • Escalates to 27 mg/m2 from days 8 and beyond, again on a schedule of days 8-9 and 15-16 out of 28 days for the remainder of cycle 1
  • It remains days 1-2, 8-9, and 15-16 at 27 mg/m2 through 12 cycles of therapy
  • Then it changes to every 2-week dosing, days 1-2 followed by days 15-16.

In this schedule, where the carfilzomib dose begins at 20 mg/m2 and only escalates to 27 mg/m2, all infusion times are 10 minutes for the carfilzomib dosing. This is somewhat confusing, and in my practice and at our institution, we have made the decision that carfilzomib dosing of 20 mg/m2 or 27 mg/m2 are all given over 10-minute durations of infusion. Any doses above that level are infused over 30-minute periods of time, as there is concern that there may be less risk of cardiac toxicity with longer infusions with higher doses of carfilzomib. Carfilzomib in conjunction with dexamethasone, or carfilzomib in conjunction with lenalidomide and dexamethasone, are very active regimens in the treatment for patients with multiple myeloma and can be given as outlined in this podcast.

Last modified: July 31, 2017