Inclusion Criteria:
1. Newly diagnosed patients with histologically confirmed Multiple Myeloma (MM) based on
the following criteria:
- Clonal plasma cells in the bone marrow
- Measurable disease within the past 4 weeks defined by any one of the following:
- Serum monoclonal protein >/= 1.0 g/dL
- Urine monoclonal protein >/= 200 mg/24 hour
- Involved serum immunoglobulin free light chain >/= 10 mg/dL and abnormal
kappa/lambda ratio 2. Evidence of underlying end organ damage and/or myeloma
defining event attributed to underlying plasma cell proliferative disorder
meeting at least one of the following:
- Hypercalcemia: serum calcium > 0.25 millimoles (mmol) /L (> 1 mg/dL) above upper limit
of normal or >/= 2.75 mmol (11 mg/dL)
- Anemia: hemoglobin value <10 g/dL or >2 g/dL below lower limit of normal
- Bone disease >/= 1 lytic lesions on skeletal X-ray, CT, or Positron Emission
Tomography (PET)-CT. For patients with 1 lytic lesion, bone marrow should demonstrate
>/=10% clonal plasma cells
- Clonal bone marrow plasma cell percentage >/=60%
- Involved/un-involved serum free light chain ratio >/=100 and involved free light chain
>/=100 mg/L
- > 1 focal lesion on magnetic resonance imaging study (lesion must be >5mm) in size
- For patients with 1 lytic lesion, bone marrow should demonstrate ≥10% clonal plasma
cells 3. Creatinine clearance (CrCl) >/=60 ml/min. CrCl can be measured or estimated
using Cockcroft-Gault method, Modification of Diet in Renal Disease (MDRD), or Chronic
Kidney Disease Epidemiology Collaboration (CKD-EPI) formulae 4. Age >/= 18 years at
the time of signing the informed consent documentation. Age limit of </= 75 years 5.
Eastern Cooperative Oncology Group (ECOG) performance status 0-2 6. Absolute
neutrophil count (ANC) >/= 1.0 K/microliter (uL), hemoglobin >/= 8 g/dL, and platelet
count >/= 75 K/uL, unless if cytopenias are deemed to be due disease at discretion of
clinical investigator. Transfusions and growth factors are permissible.
7. Adequate hepatic function, with bilirubin < 1.5 x the Upper Limit of Normal (ULN),
and Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) < 3.0 x ULN 8.
All study participants must be able to tolerate one of the following
thromboprophylactic strategies: aspirin, low molecular weight heparin or warfarin
(Coumadin) or alternative anti-coagulant 9. All study participants must be registered
into the mandatory electronic REMS (eREMS) program and be willing and able to comply
with the requirements of Risk Evaluation Management and Safety (REMS).
10) Females of childbearing potential (FCBP) must have a negative serum or urine
pregnancy test within 10-14 days and again within 24 hours prior to prescribing
lenalidomide for Cycle 1 (prescriptions must be filled within 7 days) and must either
commit to continued abstinence from heterosexual intercourse or begin two acceptable
methods of birth control, one highly effective method and one additional effective
method at the same time, at least 28 days before she starts taking lenalidomide. FCBP
must also agree to ongoing pregnancy testing. Men must agree to use a latex condom
during sexual contact with a FCBP even if they have had a successful vasectomy.
- A female of childbearing potential is a sexually mature female who: 1) has not
undergone a hysterectomy or bilateral oophorectomy; or 2) has not been naturally
postmenopausal for at least 24 consecutive months (i.e., has had menses at any time in
the preceding 24 consecutive months)
Exclusion Criteria:
1. Patients receiving >1 cycle of prior treatment or concurrent systemic treatment for
multiple myeloma:
- Treatment of hypercalcemia or spinal cord compression or aggressively progressing
myeloma with current or prior corticosteroids is permitted
- Bone targeting agents are permitted
- Concurrent or prior treatment with corticosteroids for indications other than
multiple myeloma is permitted
- Prior treatment with radiotherapy is permitted
- Prior MM treatment, such as Immunomodulating Drugs (IMIDs) or nonn-MM drugs in
clinical trials for smoldering myeloma is permitted with a washout period of 2
weeks from last dose. Smoldering patients previously treated carfilzomib are
excluded
- Patients with measurable disease who received up to one cycle of any therapy
within 60 days with a washout period of 2 weeks from last dose (on a trial or
outside a trial) are eligible (Note: Measurable disease is defined as one or more
of the following: Serum monoclonal protein ≥ 1.0 g/dL, Urine monoclonal protein ≥
200 mg/24 hour and/ or Involved serum immunoglobulin free light chain ≥ 10 mg/dL
AND abnormal kappa/lambda ratio)
2. Plasma cell leukemia
3. Polyneuropathy, Organomegaly, Endocrinopathy, Myeloma protein, and Skin changes
(POEMS) syndrome
4. Amyloidosis
5. Has known chronic obstructive pulmonary disease with a forced expiratory volume in 1
second (FEV1) <50% of predicted normal (note that FEV1 testing is required for
subjects suspected of having chronic obstructive pulmonary disease and subjects must
be excluded if FEV1 <50% of predicted normal).
6. Pregnant or lactating females. Because there is a potential risk for adverse events
nursing infants secondary to treatment of the mother with carfilzomib in combination
with lenalidomide. These potential risks may also apply to other agents used in this
study.
7. Uncontrolled hypertension (i.e. systolic BP >160 mmHg, diastolic BP > 100 mmHg) or or
diabetes
8. Active hepatitis B or C infection
9. Subject is:
- Seropositive for human immunodeficiency virus (HIV)
- Seropositive for hepatitis B (defined by a positive test for hepatitis B surface
antigen [HBsAg]). Subjects with resolved infection (ie, subjects who are HBsAg
negative but positive for antibodies to hepatitis B core antigen (anti-HBc)
and/or antibodies to hepatitis B surface antigen [anti-HBs]) must be screened
using real-time polymerase chain reaction (PCR) measurement of hepatitis B virus
(HBV) DNA levels. Those who are PCR positive will be excluded. Exception:
Subjects with serologic findings suggestive of HBV vaccination (anti-HBs
positivity as the only serologic marker) AND a known history of prior HBV
vaccination, do not need to be tested for HBV DNA by Polymerase Chain Reaction
(PCR).
- Seropositive for hepatitis C (except in the setting of a sustained virologic
response (SVR), defined as aviremia at least 12 weeks after completion of
antiviral therapy).
10. Significant cardiovascular disease with New York Heart Association (NYHA) class III or
IV symptoms, symptomatic ischemia, current uncontrolled arrhythmias, screening ECG
with corrected QT interval (QTc) of > 470 msec, pericardial disease, or myocardial
infarction within 4 months prior to randomization and Left ventricular ejection
fraction < 40% assessed by transthoracic echocardiogram (ECHO),Current unstable angina
as determined by history and physical exam, hypertrophic cardiomyopathy or restrictive
cardiomyopathy
11. Pulmonary hypertension
12. Has refractory Gastrointestinal (GI) disease with refractory nausea/vomiting,
inflammatory bowel disease, or bowel resection that would prevent absorption of oral
agents
13. Uncontrolled intercurrent illness including but not limited to active infection or
psychiatric illness/social situations that would compromise compliance with study
requirements
14. Significant neuropathy >/= Grade 3 or Grade 2 neuropathy with pain at baseline
15. Contraindication to any concomitant medication, including antivirals or
anticoagulation.
16. Major surgery within 3 weeks prior to first dose
