注射用KYPROLIS(carfilzomib)是一种抗肿瘤药物只供利用静脉使用，是一种蛋白酶体抑制剂适用为治疗多发性骨髓瘤患者。
美国食品和药物管理局7月20日批准Kyprolis（卡非佐米）用于此前至少经过两个优先疗法包括万珂（硼替佐米）和免疫调节剂治疗的多发性骨髓瘤患者的治疗。
多发性骨髓瘤是发生在血浆细胞中的血癌，它通常生长在骨髓、大多数的骨骼海绵软组织内。血细胞由骨髓生产。根据美国癌症协会预测，2012年将有21700人被诊断出患有多发性骨髓瘤，10710将死于这种疾病。
通过对266例事先接受了硼替佐米和沙利度胺治疗的多发性骨髓瘤复发患者进行的临床研究，对Kyprolis的安全性和有效性进行了评估。
此项研究的目的是测定治疗后肿瘤完全或部分消失患者比例（总响应率）。总响应率23％。响应时间中位数为7.8个月。
在超过30％的参加研究者中观察到的最常见副作用有疲劳、低血细胞计数和血小板水平、气短、腹泻、发烧。观察到的与Kyprolis有关的严重副作用包括心脏衰竭和呼吸急促。如果发生这些严重副作用，应密切监测患者并予治疗。
Kyprolis是通过FDA加速审批程序获批的，加速审批程序允许FDA依据临床试验数据显示出的能够合理预测临床效益的替代终点审批治疗严重疾病的药物。加速审批程序旨在为患者更早地提供充满希望的新药物。在该药物批准上市后，公司还须提交确认药物临床效益的更多的临床资料。
【作用机制】
Carfilzomib是一种四肽基环氧骨架蛋白酶体抑制剂不可逆地结合至20S蛋白酶体含苏氨酸N-端活性部 位，26S蛋白酶体内蛋白水解核心颗粒。Carfilzomib有抗增殖和凋亡活性在体外在实体和血液学中粒细胞。在动物中，carfilzomib抑制 蛋白酶体活性在血液和组织和在多发性骨髓瘤，血液学，和实体瘤模型中延迟肿瘤生长。
【适应证和用途】
KYPROLIS是一种蛋白酶体抑制剂适用为治疗多发性骨髓瘤患者，患者曾接收至少两种既往治疗包括硼替佐米和一种免疫调节药和曾证实疾病进展或末次治疗完成的60天内。批准是根据反应率。尚未证明临床获益，例如活存或症状改善。
【剂量和给药方法】
（1）每周连续2天历时2至10分钟静脉给药共三周(第1，2，8，9，15，和16天)，接着12-天休息期(第17至28天)。
（2）推荐疗程1剂量是20 mg/m2/day和如果耐受增加第2疗程剂量和随后疗程剂量至27 mg/m2/day。
（3）给药前和后水化患者。
（4）在所有第1疗程剂量前用地塞米松预先给药。在第一疗程剂量递增期，和如果发生或再次出现输注反应症状时。
（5）根据毒性修改给药。
【剂型和规格】
单次使用小瓶：60mg无菌冻干粉
【禁忌证】
无
【警告和注意事项】
（1）心脏不良反应包括心衰和缺血：监视心脏并发症。及时治疗和中止KYPROLIS。
（2）肺动脉高压：如果怀疑中止给药。
（3）肺部并发症：监视和立即处理呼吸困难，中断KYPROLIS 直至症状已解决或恢复至基线。
（4）输注反应：用地塞米松预先给药预防。
（5）忠告患者如果发生症状立即寻医学注意。
（6）血小板减少：监视血小板计数；当临床上指示减低或中断给药。
（8）胚胎胎儿毒性：KYPROLIS可致胎儿危害。有生育能力女性当正在治疗时应避免成为妊娠。
【不良反应】
最常报道的不良反应(发生率 ≥ 30%)是疲乏，贫血，恶心，血小板减少，呼吸困难，腹泻，和发热.
特殊人群中使用
• 正在透析患者：透析操作后给予KYPROLIS。
【贮存和处置】
未开封小瓶应准存在冰箱(2°C至8°C; 36°F至46°F)。保留在原包装避光保护。

Kyprolis® (carfilzomib) for Injection is a second-generation proteasome inhibitor that selectively binds to the proteasome for sustained inhibition.1-3
KYPROLIS is indicated for the treatment of patients with multiple myeloma who have received at least 2 prior therapies including bortezomib and an immunomodulatory agent and have demonstrated disease progression on or within 60 days of completion of the last therapy.
INDICATION AND IMPORTANT SAFETY INFORMATION
INDICATION
Kyprolis® (carfilzomib) for Injection is indicated for the treatment of patients with multiple myeloma who have received at least 2 prior therapies including bortezomib and an immunomodulatory agent and have demonstrated disease progression on or within 60 days of completion of the last therapy. Approval is based on response rate. Clinical benefit, such as improvement in survival or symptoms, has not been verified.
CONTRAINDICATIONS
None.
WARNINGS AND PRECAUTIONS
The safety of KYPROLIS was evaluated in clinical studies of 526 patients with relapsed and/or refractory multiple myeloma.
Cardiac Arrest, Congestive Heart Failure, Myocardial Ischemia: Death due to cardiac arrest has occurred within a day of KYPROLIS administration. New onset or worsening of pre-existing congestive heart failure with decreased left ventricular function or myocardial ischemia have occurred following administration of KYPROLIS. Cardiac failure events (e.g., cardiac failure congestive, pulmonary edema, ejection fraction decreased) were reported in 7% of patients. Monitor for cardiac complications and manage promptly. Withhold KYPROLIS for Grade 3 or 4 cardiac events until recovery and consider whether to restart KYPROLIS based on a benefit/risk assessment. Patients with New York Heart Association Class III and IV heart failure, myocardial infarction in the preceding 6 months, and conduction abnormalities uncontrolled by medications may be at greater risk for cardiac complications.
Pulmonary Hypertension: Pulmonary arterial hypertension (PAH) was reported in 2% of patients treated with KYPROLIS and was Grade 3 or greater in less than 1% of patients. Evaluate with cardiac imaging and/or other tests as indicated. Withhold KYPROLIS for pulmonary hypertension until resolved or returned to baseline and consider whether to restart KYPROLIS based on a benefit/risk assessment.
Pulmonary Complications: Dyspnea was reported in 35% of patients enrolled in clinical trials. Grade 3 dyspnea occurred in 5%; no Grade 4 events, and 1 death (Grade 5) was reported. Monitor and manage dyspnea immediately; interrupt KYPROLIS until symptoms have resolved or returned to baseline.
Infusion Reactions: Infusion reactions were characterized by a spectrum of systemic symptoms including fever, chills, arthralgia, myalgia, facial flushing, facial edema, vomiting, weakness, shortness of breath, hypotension, syncope, chest tightness, or angina. These reactions can occur immediately following infusion or up to 24 hours after administration of KYPROLIS. Administer dexamethasone prior to KYPROLIS to reduce the incidence and severity of reactions. Inform patients of the risk and symptoms, and to contact physician if symptoms of an infusion reaction occur.
Tumor Lysis Syndrome: Tumor lysis syndrome (TLS) occurred following KYPROLIS administration in < 1% of patients. Patients with multiple myeloma and a high tumor burden should be considered to be at greater risk for TLS. Prior to receiving KYPROLIS, ensure that patients are well hydrated. Monitor for evidence of TLS during treatment, and manage promptly. Interrupt KYPROLIS until TLS is resolved.
Thrombocytopenia: KYPROLIS causes thrombocytopenia with platelet nadirs occurring around Day 8 of each 28-day cycle and recovery to baseline by the start of the next 28-day cycle. In patients with multiple myeloma, 36% of patients experienced thrombocytopenia, including Grade 4 in 10%. Thrombocytopenia following KYPROLIS administration resulted in a dose reduction in 1% of patients and discontinuation of treatment with KYPROLIS in < 1% of patients. Monitor platelet counts frequently during treatment with KYPROLIS. Reduce or interrupt dose as clinically indicated.
Hepatic Toxicity and Hepatic Failure: Cases of hepatic failure, including fatal cases, have been reported (< 1%). KYPROLIS can cause elevations of serum transaminases and bilirubin. Withhold KYPROLIS in patients experiencing Grade 3 or greater elevations of transaminases, bilirubin, or other liver enzyme abnormalities until resolved or returned to baseline. After resolution, consider if restarting KYPROLIS is appropriate. Monitor liver enzymes frequently.
Embryo-fetal Toxicity: KYPROLIS can cause fetal harm when administered to a pregnant woman based on its mechanism of action and findings in animals. There are no adequate and well-controlled studies in pregnant women using KYPROLIS. Carfilzomib caused embryo-fetal toxicity in pregnant rabbits at doses that were lower than in patients receiving the recommended dose. Females of reproductive potential should be advised to avoid becoming pregnant while being treated with KYPROLIS.
ADVERSE REACTIONS
Serious adverse reactions were reported in 45% of patients. The most common serious adverse reactions were pneumonia (10%), acute renal failure (4%), pyrexia (3%), and congestive heart failure (3%). Adverse reactions leading to discontinuation of KYPROLIS occurred in 15% of patients and included congestive heart failure (2%), cardiac arrest, dyspnea, increased blood creatinine, and acute renal failure (1% each).
The most common adverse reactions (incidence ≥ 30%) were fatigue (56%), anemia (47%), nausea (45%), thrombocytopenia (36%), dyspnea (35%), diarrhea (33%), and pyrexia (30%).
USE IN SPECIFIC POPULATIONS
Since dialysis clearance of KYPROLIS concentrations has not been studied, the drug should be administered after the dialysis procedure.
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产地国家: 美国
原产地英文商品名:
Kyprolis Powder 60mg Vial
原产地英文药品名:
Carfilzomib
中文参考商品译名:
Kyprolis 粉剂 60毫克/支
中文参考药品译名:
卡非佐米
生产厂家英文名:
Onyx Pharmaceuticals