Peripheral neuropathy experience in patients with relapsed and/or refractory multiple myeloma treated with carfilzomib.

Peripheral neuropathy (PN) is frequently seen in patients with multiple myeloma (MM) and commonly arises as a consequence of the disease itself and as an adverse effect of anti-MM treatment. Treatment-induced PN may occur in up to 75% of patients receiving anti-MM treatment (particularly in those receiving a thalidomide- or bortezomib-based regimen), and its occurrence often leads to dose reductions or treatment discontinuation, which may ultimately affect response to therapy. Carfilzomib, a highly selective proteasome inhibitor, was recently approved in the United States for the treatment of patients with relapsed and refractory MM. Carfilzomib is associated with a low incidence of PN and minimal off-target effects. This article reviews the etiology and incidence of PN with current novel anti-myeloma therapies and includes clinical trial data with respect to PN in 526 patients treated with carfilzomib for relapsed and/or refractory MM. The use of carfilzomib in patients with a history of PN and the incidence of new-onset PN in carfilzomib-treated patients are considered, and a clinical perspective on the management of PN in these patients is provided.