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FDA Approves New Kyprolis (Carfilzomib) Combination Therapy For The Treatment Of Patients With Relapsed Or Refractory Multiple Myeloma

Published: Jan 21, 2016 4:32 pm
  • Pivotal Head-To-Head ENDEAVOR Study Shows Kyprolis and Dexamethasone Doubled Progression-Free Survival Versus Velcade® (Bortezomib) and Dexamethasone
  • Kyprolis Label Expansion Represents Critical Advancement for Patients With Relapsed or Refractory Multiple Myeloma, Offering New Option For Backbone Therapy
  • Approval Expands Kyprolis Indication and Converts Monotherapy Indication to Full Approval

FDA Approves New Kyprolis (Carfilzomib) Combination Therapy For The Treatment Of Patients With Relapsed Or Refractory Multiple Myeloma Thousand Oaks, CA (Press Release) – Amgen (NASDAQ: AMGN) today announced that the U.S. Food and Drug Admin­istra­tion (FDA) has approved the supple­mental New Drug Application (sNDA) of Kyprolis® (car­filz­o­mib) for Injection in com­bi­na­tion with dexa­meth­a­sone or with lena­lido­mide plus dexa­meth­a­sone for the treat­ment of patients with re­lapsed or refractory multiple myeloma who have received one to three lines of ther­apy. The FDA also approved Kyprolis as a single agent for the treat­ment of patients with re­lapsed or refractory multiple myeloma who have received one or more lines of ther­apy. This FDA de­ci­sion converts to full approval the initial accelerated approval Kyprolis received in July 2012 as a single agent.

"Kyprolis is the only approved ther­apy for re­lapsed multiple myeloma with proven efficacy as a single agent, doublet and triplet com­bi­na­tion that is offered in a variety of doses to meet individual patient needs," said Sean E. Harper, M.D., exec­u­tive vice pres­i­dent of Research and Development at Amgen. "Importantly, this new approval sup­ports the use of Kyprolis as a back­bone ther­apy for the man­agement of re­lapsed multiple myeloma, a dif­fi­cult-to-treat blood cancer."

"Multiple myeloma remains an incurable disease where relapse inevitably occurs and over time patients become resistant to treat­ments," said Dr. Ruben Niesvizky, director of the Multiple Myeloma Center at Weill Cornell Medicine and New York-Presbyterian/Weill Cornell Medical Center. "As a clinician, I'm pleased with the tremendous progress that we have seen in the past 12 months in multiple myeloma treat­ment. This FDA approval is im­por­tant because it provides physicians with flexible options for Kyprolis use in helping to man­age this chal­leng­ing disease."

The approval is based on results from the Phase 3 head-to-head ENDEAVOR study. This was a superiority trial in which the pri­mary end­point was pro­gres­sion-free survival (PFS). The data showed patients with re­lapsed multiple myeloma treated with Kyprolis and dexa­meth­a­sone achieved 50 per­cent greater PFS of 18.7 months compared to 9.4 months in those receiving Velcade® (bor­tez­o­mib) and dexa­meth­a­sone (HR=0.53; 95 per­cent CI: 044, 0.65 p<0.0001), a current standard of care in re­lapsed multiple myeloma. Patients in the study were treated until disease pro­gres­sion. The most common adverse reac­tions (greater than or equal to 20 per­cent) in the Kyprolis arm were anemia, diarrhea, dyspnea, fatigue, insomnia, pyrexia and thrombo­cytopenia.

This new indi­ca­tion for Kyprolis is the second in six months. In July 2015, the FDA approved another ex­panded indi­ca­tion for Kyprolis in com­bi­na­tion with lena­lido­mide and dexa­meth­a­sone (KRd) for the treat­ment of patients with multiple myeloma who have received one to three prior lines of ther­apy.

Multiple myeloma is an incurable blood cancer, char­ac­ter­ized by a recurring pattern of remission and re­lapse.1 It is a rare and very aggressive disease that accounts for approx­i­mately one per­cent of all cancers.2-4 In the U.S., there are nearly 90,000 people living with, or in remission from, multiple myeloma.5 Approximately, 26,850 Americans are diag­nosed with multiple myeloma each year and 11,240 patient deaths are reported on an annual basis.5

About ENDEAVOR

The ran­dom­ized ENDEAVOR (RandomizEd, OpeN Label, Phase 3 Study of Carfilzomib Plus DExa­methA­sone Vs Bortezomib Plus DexamethasOne in Patients With Relapsed Multiple Myeloma) trial of 929 patients eval­u­ated Kyprolis in com­bi­na­tion with low-dose dexa­meth­a­sone (Kd), versus bor­tez­o­mib with low-dose dexa­meth­a­sone in patients whose multiple myeloma has re­lapsed after at least one, but not more than three prior thera­peutic regi­mens. The pri­mary end­point of the trial was PFS, defined as the time from treat­ment initiation to disease pro­gres­sion or death. In a clin­i­cal trial, measuring the PFS is one way to dem­onstrate how well a treat­ment works.6

As stated above, Kd was superior to bor­tez­o­mib and dexa­meth­a­sone (Vd) and dem­onstrated sig­nif­i­cantly longer PFS. Improvement in PFS in the Kd arm compared to the Vd arm was seen across all pre-specified subgroups, in­­clud­ing bor­tez­o­mib-naïve patients, those with high- or standard-risk cytogenetics and with or without prior trans­plan­ta­tion.

Kd also dem­onstrated im­prove­ment over Vd for sec­ond­ary end­points, achieving a higher over­all response rate (77 per­cent vs. 63 per­cent; p<0.0001) and lower rate of grade 2 or higher neu­rop­athy events (6 per­cent [95 per­cent CI: 4, 8] vs. 32 per­cent [95 per­cent CI: 28, 36]). In the Kyprolis and bor­tez­o­mib groups, 54.3 per­cent and 28.6 per­cent of patients achieved a very good partial response or better (p<0.0001), and 12.5 per­cent and 6.2 per­cent of patients achieved a com­plete response or better (p<0.0001), re­spec­tive­ly. Overall survival data are not yet mature and con­tinue to be monitored.

Treatment dis­con­tinu­a­tion due to adverse events and on-study deaths were com­parable be­tween the two arms. A number of known adverse drug reac­tions were reported at a higher rate in the Kyprolis group compared with the bor­tez­o­mib group, in­­clud­ing any-grade dyspnea, hyper­tension, pyrexia, and cough as were any-grade cardiac failure (grouped term; 8 per­cent vs. 3 per­cent) and acute renal failure (grouped term; 8 per­cent vs. 5 per­cent).

Rates of grade 3 or higher adverse events were 73 per­cent in the Kyprolis group and 67 per­cent in the bor­tez­o­mib group. Grade 3 or higher adverse events of interest in the Kyprolis and bor­tez­o­mib groups in­cluded hyper­tension (preferred term; 9 per­cent vs. 3 per­cent), dyspnea (preferred term; 5 per­cent vs. 2 per­cent), cardiac failure (grouped term; 5 per­cent vs. 2 per­cent), acute renal failure (grouped term; 4 per­cent vs. 3 per­cent), ischemic heart disease (grouped term; 2 per­cent vs. 2 per­cent) and pul­mo­nary hyper­tension (grouped term; 0.6 per­cent vs. 0.2 per­cent).

Patients received treat­ment until pro­gres­sion with Kyprolis as a 30-minute infusion on days 1, 2, 8, 9, 15 and 16 of 28 day treat­ment cycles, along with low-dose dexa­meth­a­sone (20 mg). For Cycle 1 only, Kyprolis was admin­istered at 20 mg/m2 on days 1 and 2, and if tolerated followed by escalation to 56 mg/m2 from day 8. Patients who tolerated 56 mg/m2 in Cycle 1 were kept at this dose for sub­se­quent cycles. Patients who received bor­tez­o­mib (1.3 mg/m2) with low-dose dexa­meth­a­sone (20 mg) were admin­istered bor­tez­o­mib sub­cu­taneously or in­tra­venously at the discretion of the investigator and in accordance with regu­la­tory approval of bor­tez­o­mib. More than 75 per­cent of the patients in the control arm received bor­tez­o­mib sub­cu­taneously. This study was conducted at 235 sites world­wide. For in­­for­ma­tion about this trial, please visit www.clinicaltrials.gov under trial identi­fi­ca­tion number NCT01568866.

About Kyprolis® (car­filz­o­mib)

Proteasomes play an im­por­tant role in cell function and growth by breaking down proteins that are damaged or no longer needed.7 Kyprolis has been shown to block pro­te­a­somes, leading to an excessive build-up of proteins within cells.8 In some cells, Kyprolis can cause cell death, especially in myeloma cells because they are more likely to con­tain a higher amount of ab­nor­mal proteins.8 The irreversibility of Kyprolis' binding has also been shown to offer a more sustained inhibition of the targeted enzymes.9

Kyprolis is approved in the U.S. for the fol­low­ing:

  • In combination with dexa­meth­a­sone or with lenalidomide plus dexa­meth­a­sone for the treatment of patients with relapsed or refractory multiple myeloma who have received one to three lines of therapy.
  • As a single agent for the treatment of patients with relapsed or refractory multiple myeloma who have received one or more lines of therapy.

Kyprolis is also approved in Argentina, Israel, Kuwait, Mexico, Thailand, Colombia, Korea, Canada and the European Union. Additional regu­la­tory appli­ca­tions for Kyprolis are underway and have been submitted to health author­i­ties world­wide.

Kyprolis is a prod­uct of Onyx Pharma­ceu­ticals, Inc. Onyx Pharma­ceu­ticals is a sub­sid­i­ary of Amgen and holds devel­op­ment and com­mer­cial­iza­tion rights to Kyprolis globally, excluding Japan.

For more in­­for­ma­tion, please visit www.kyprolis.com.

Patient Support Program

Amgen is proud to offer Onyx Pharma­ceu­ticals 360® (Onyx 360) which is a patient sup­port pro­gram designed to provide personalized services to patients living with cancer. Upon enrollment, patients are paired with a dedicated Onyx 360 Oncology Nurse Ambassador who is trained to help navigate their treat­ment journey and address daily and long term con­cerns. Onyx 360 also provides access to a network of resources and third-party services in­­clud­ing transportation, emotional sup­port and financial and prod­uct reim­burse­ment assistance. Onyx 360 services are provided to patients at no cost. For more in­­for­ma­tion, please visit www.kyprolis.com/support-during-treatment.

Important Safety Information Regarding Kyprolis® (car­filz­o­mib) for Injection

INDICATION(S)

  • KYPROLIS® (carfilzomib) is indicated in combination with dexa­meth­a­sone or with lenalidomide plus dexa­meth­a­sone for the treatment of patients with relapsed or refractory multiple myeloma who have received one to three lines of therapy.
  • KYPROLIS® (carfilzomib) is indicated as a single agent for the treatment of patients with relapsed or refractory multiple myeloma who have received one or more lines of therapy.

IMPORTANT SAFETY INFORMATION

Cardiac Toxicities

  • New onset or worsening of pre-existing cardiac failure (e.g., congestive heart failure, pulmonary edema, decreased ejection fraction), restrictive cardiomyopathy, myocardial ischemia, and myocardial infarction including fatalities have occurred following administration of KYPROLIS. Some events occurred in patients with normal baseline ventricular function. Death due to cardiac arrest has occurred within one day of KYPROLIS administration.
  • Monitor patients for clinical signs or symptoms of cardiac failure or cardiac ischemia. Evaluate promptly if cardiac toxicity is suspected. Withhold KYPROLIS for Grade 3 or 4 cardiac adverse events until recovery, and consider whether to restart KYPROLIS at 1 dose level reduction based on a benefit/risk assessment.
  • While adequate hydration is required prior to each dose in Cycle 1, monitor all patients for evidence of volume overload, especially patients at risk for cardiac failure. Adjust total fluid intake as clinically appropriate in patients with baseline cardiac failure or who are at risk for cardiac failure.
  • Patients > 75 years, the risk of cardiac failure is increased. Patients with New York Heart Association Class III and IV heart failure, recent myocardial infarction, conduction abnormalities, angina, or arrhythmias may be at greater risk for cardiac complications and should have a comprehensive medical assessment (including blood pressure and fluid management) prior to starting treatment with KYPROLIS and remain under close follow-up.

Acute Renal Failure

  • Cases of acute renal failure and renal insufficiency adverse events (including renal failure) have occurred in patients receiving KYPROLIS. Acute renal failure was reported more frequently in patients with advanced relapsed and refractory multiple myeloma who received KYPROLIS monotherapy. Monitor renal function with regular measurement of the serum creatinine and/or estimated creatinine clearance. Reduce or withhold dose as appropriate.

Tumor Lysis Syndrome

  • Cases of Tumor Lysis Syndrome (TLS), including fatal outcomes, have occurred in patients receiving KYPROLIS. Patients with multiple myeloma and a high tumor burden should be considered at greater risk for TLS. Adequate hydration is required prior to each dose in Cycle 1, and in subsequent cycles as needed. Consider uric acid lowering drugs in patients at risk for TLS. Monitor for evidence of TLS during treatment and manage promptly. Withhold KYPROLIS until TLS is resolved.

Pulmonary Toxicity

  • Acute Respiratory Distress Syndrome (ARDS), acute respiratory failure, and acute diffuse infiltrative pulmonary disease such as pneumonitis and interstitial lung disease have occurred in patients receiving KYPROLIS. Some events have been fatal. In the event of drug-induced pulmonary toxicity, discontinue KYPROLIS.

Pulmonary Hypertension

  • Pulmonary arterial hypertension (PAH) was reported in patients treated with KYPROLIS. Evaluate with cardiac imaging and/or other tests as indicated. Withhold KYPROLIS for PAH until resolved or returned to baseline and consider whether to restart KYPROLIS based on a benefit/risk assessment.

Dyspnea

  • Dyspnea was reported in patients treated with KYPROLIS. Evaluate dyspnea to exclude cardio­pul­mo­nary conditions including cardiac failure and pulmonary syndromes. Stop KYPROLIS for Grade 3 or 4 dyspnea until resolved or returned to baseline. Consider whether to restart KYPROLIS based on a benefit/risk assessment.

Hypertension

  • Hypertension, including hypertensive crisis and hypertensive emergency, has been observed with KYPROLIS. Some of these events have been fatal. Monitor blood pressure regularly in all patients. If hypertension cannot be adequately controlled, withhold KYPROLIS and evaluate. Consider whether to restart KYPROLIS based on a benefit/risk assessment.

Venous Thrombosis

  • Venous thromboembolic events (including deep venous thrombosis and pulmonary embolism) have been observed with KYPROLIS. Thrombo­pro­phy­laxis is recommended for patients being treated with the combination of KYPROLIS with dexa­meth­a­sone or with lenalidomide plus dexa­meth­a­sone. The thrombo­pro­phylaxis regimen should be based on an assessment of the patient's underlying risks.
  • Patients using oral contraceptives or a hormonal method of contraception associated with a risk of thrombosis should consider an alternative method of effective contraception during treatment with KYPROLIS in combination with dexa­meth­a­sone or lenalidomide plus dexa­meth­a­sone.

Infusion Reactions

  • Infusion reactions, including life-threatening reactions, have occurred in patients receiving KYPROLIS. Symptoms include 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 or up to 24 hours after administration of KYPROLIS. Premedicate with dexa­meth­a­sone to reduce the incidence and severity of infusion reactions. Inform patients of the risk and of symptoms of an infusion reaction and to contact a physician immediately if they occur.

Thrombocytopenia

  • KYPROLIS causes thrombocytopenia with recovery to baseline platelet count usually by the start of the next cycle. Thrombocytopenia was reported in patients receiving KYPROLIS. Monitor platelet counts frequently during treatment with KYPROLIS. Reduce or withhold dose as appropriate.

Hepatic Toxicity and Hepatic Failure

  • Cases of hepatic failure, including fatal cases, have been reported during treatment with KYPROLIS. KYPROLIS can cause increased serum transaminases. Monitor liver enzymes regularly regardless of baseline values. Reduce or withhold dose as appropriate.

Thrombotic Microangiopathy

  • Cases of thrombotic microangiopathy, including thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS), including fatal outcome have occurred in patients receiving KYPROLIS. Monitor for signs and symptoms of TTP/HUS. Discontinue KYPROLIS if diagnosis is suspected. If the diagnosis of TTP/HUS is excluded, KYPROLIS may be restarted. The safety of reinitiating KYPROLIS therapy in patients previously experiencing TTP/HUS is not known.

Posterior Reversible Encephalopathy Syndrome (PRES)

Cases of PRES have occurred in patients receiving KYPROLIS. PRES was formerly known as Reversible Posterior Leukoencephalopathy Syndrome. Consider a neuroradiological imaging (MRI) for onset of visual or neurological symp­toms. Discontinue KYPROLIS if PRES is sus­pected and eval­u­ate. The safety of reinitiating KYPROLIS ther­apy in patients pre­vi­ously experiencing PRES is not known.

Embryo-fetal Toxicity

  • KYPROLIS can cause fetal harm when administered to a pregnant woman based on its mechanism of action and findings in animals.
  • Females of reproductive potential should be advised to avoid becoming pregnant while being treated with KYPROLIS. Males of reproductive potential should be advised to avoid fathering a child while being treated with KYPROLIS. If this drug is used during pregnancy, or if pregnancy occurs while taking this drug, the patient should be apprised of the potential hazard to the fetus.

ADVERSE REACTIONS

  • The most common adverse events occurring in at least 20% of patients treated with KYPROLIS in the combination therapy trials: anemia, neutropenia, diarrhea, dyspnea, fatigue, thrombocytopenia, pyrexia, insomnia, muscle spasm, cough, upper respiratory tract infection, hypokalemia.
  • The most common adverse events occurring in at least 20% of patients treated with KYPROLIS in monotherapy trials: anemia, fatigue, thrombocytopenia, nausea, pyrexia, dyspnea, diarrhea, headache, cough, edema peripheral.

Please see full Prescribing Information at www.kyprolis.com.

About Amgen

Amgen is committed to unlocking the poten­tial of biology for patients suffering from serious illnesses by discovering, devel­op­ing, manu­fac­tur­ing and delivering inno­va­tive human thera­peutics. This ap­proach begins by using tools like ad­vanced human genetics to unravel the complexities of disease and under­stand the fundamentals of human biology.

Amgen focuses on areas of high unmet medical need and leverages its biologics manu­fac­tur­ing expertise to strive for solu­tions that im­prove health out­comes and dramatically im­prove people's lives. A bio­technology pioneer since 1980, Amgen has grown to be one of the world's leading independent bio­technology com­panies, has reached millions of patients around the world and is devel­op­ing a pipe­line of medicines with break­away poten­tial.

For more in­­for­ma­tion, visit www.amgen.com and follow us on www.twitter.com/amgen.

Forward Looking Statements

This news release con­tains forward-looking state­ments that are based on the current ex­pec­ta­tions and beliefs of Amgen Inc. and its sub­sid­i­aries (Amgen, we or us) and are subject to a number of risks, un­cer­tain­ties and assump­tions that could cause actual results to differ ma­teri­ally from those described. All state­ments, other than state­ments of historical fact, are state­ments that could be deemed forward-looking state­ments, in­­clud­ing esti­mates of revenues, operating margins, capital ex­pen­di­tures, cash, other financial metrics, ex­pec­ted legal, arbitration, political, regu­la­tory or clin­i­cal results or practices, customer and prescriber patterns or practices, reim­burse­ment activities and out­comes and other such esti­mates and results. Forward-looking state­ments involve sig­nif­i­cant risks and un­cer­tain­ties, in­­clud­ing those discussed below and more fully described in the Securities and Exchange Com­mis­sion (SEC) reports filed by Amgen Inc., in­­clud­ing Amgen Inc.'s most recent annual report on Form 10-K and any sub­se­quent periodic reports on Form 10-Q and Form 8-K. Please refer to Amgen Inc.'s most recent Forms 10-K, 10-Q and 8-K for addi­tional in­­for­ma­tion on the un­cer­tain­ties and risk factors related to our business. Unless other­wise noted, Amgen is providing this in­­for­ma­tion as of Jan. 21, 2016, and expressly disclaims any duty to update in­­for­ma­tion con­tained in this news release.

No forward-looking state­ment can be guar­an­teed and actual results may differ ma­teri­ally from those we project. Discovery or identi­fi­ca­tion of new prod­uct can­di­dates or devel­op­ment of new indi­ca­tions for existing prod­ucts cannot be guar­an­teed and movement from concept to prod­uct is uncertain; consequently, there can be no guar­an­tee that any particular prod­uct can­di­date or devel­op­ment of a new indi­ca­tion for an existing prod­uct will be suc­cess­ful and become a commercial prod­uct. Further, pre­clin­i­cal results do not guar­an­tee safe and effective per­for­mance of prod­uct can­di­dates in humans. The complexity of the human body cannot be perfectly, or sometimes, even adequately modeled by computer or cell cul­ture systems or animal models. The length of time that it takes for us and our partners to com­plete clin­i­cal trials and obtain regu­la­tory approval for prod­uct market­ing has in the past varied and we ex­pec­t similar variability in the future. We develop prod­uct can­di­dates internally and through licensing col­lab­o­rations, part­ner­ships and joint ventures. Product can­di­dates that are derived from rela­tion­ships may be subject to disputes be­tween the parties or may prove to be not as effective or as safe as we may have believed at the time of entering into such rela­tion­ship. Also, we or others could identify safety, side effects or manu­fac­tur­ing problems with our prod­ucts after they are on the market. Our business may be impacted by gov­ern­ment in­ves­ti­ga­tions, litigation and prod­uct liability claims. If we fail to meet the compliance obli­ga­tions in the corporate integrity agree­ment be­tween us and the U.S. gov­ern­ment, we could become subject to sig­nif­i­cant sanctions. We depend on third parties for a sig­nif­i­cant portion of our manu­fac­tur­ing capacity for the supply of certain of our current and future prod­ucts and limits on supply may constrain sales of certain of our current prod­ucts and prod­uct can­di­date devel­op­ment.

In addi­tion, sales of our prod­ucts (including prod­ucts of our wholly-owned sub­sid­i­aries) are affected by the reim­burse­ment policies imposed by third-party payers, in­­clud­ing gov­ern­ments, private insurance plans and man­aged care providers and may be affected by regu­la­tory, clin­i­cal and guideline devel­op­ments and domestic and inter­na­tional trends to­ward man­aged care and health­care cost con­tainment as well as U.S. legislation affecting pharma­ceu­tical pricing and reim­burse­ment. Government and others' reg­u­la­tions and reim­burse­ment policies may affect the devel­op­ment, usage and pricing of our prod­ucts. In addi­tion, we compete with other com­pa­nies with respect to some of our marketed prod­ucts as well as for the discovery and devel­op­ment of new prod­ucts. We believe that some of our newer prod­ucts, prod­uct can­di­dates or new indi­ca­tions for existing prod­ucts, may face com­pe­ti­tion when and as they are approved and marketed. Our prod­ucts may compete against prod­ucts that have lower prices, estab­lish­ed reim­burse­ment, superior per­for­mance, are easier to admin­ister, or that are other­wise competitive with our prod­ucts. In addi­tion, while we and our partners routinely obtain patents for our and their prod­ucts and tech­nology, the protection of our prod­ucts offered by patents and patent appli­ca­tions may be chal­lenged, invalidated or circumvented by our or our partners' com­pet­i­tors and there can be no guar­an­tee of our or our partners' ability to obtain or main­tain patent protection for our prod­ucts or prod­uct can­di­dates. We cannot guar­an­tee that we will be able to produce commercially suc­cess­ful prod­ucts or main­tain the commercial success of our existing prod­ucts. Our stock price may be affected by actual or perceived market oppor­tu­ni­ty, competitive position, and success or failure of our prod­ucts or prod­uct can­di­dates. Further, the discovery of sig­nif­i­cant problems with a prod­uct similar to one of our prod­ucts that implicate an entire class of prod­ucts could have a ma­teri­al adverse effect on sales of the affected prod­ucts and on our business and results of operations. Our efforts to integrate the operations of com­pa­nies we have acquired may not be suc­cess­ful. We may ex­peri­ence dif­fi­culties, delays or unexpected costs and not achieve antic­i­pated benefits and savings from our ongoing restructuring plan. Our business per­for­mance could affect or limit the ability of our Board of Directors to declare a dividend or our ability to pay a dividend or repurchase common stock.

References

  1. Jakubowiak A. Management Strategies for Relapsed/Refractory Multiple Myeloma: Current Clinical Perspectives. Seminars in Hematology. 2012; 49(3)(1),S16-S32.
  2. GLOBCAN 2012. Global Prevalence and Incidence. Available at: http://globocan.iarc.fr/old/summary_table_pop_prev.asp?selection=224900&amp;title=World&amp;sex=0&amp;window=1&amp;sort=0&amp;submit=%C2%A0Execute%C2%A0. Accessed on January 13, 2016.
  3. American Cancer Society. Multiple Myeloma. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003121-pdf.pdf. Accessed on January 13, 2016.
  4. Palumbo A and Anderson K. Multiple myeloma. N Engl J Med. 2011;364:1046–60.
  5. National Cancer Institute. SEER Stat Fact Sheets: Myeloma. Available at: http://seer.cancer.gov/statfacts/html/mulmy.html. Accessed on January 13, 2016.
  6. National Cancer Institute. NCI Dictionary of Cancer Terms. Available at: http://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=44782. Accessed on January 13, 2016.
  7. Moreau P, Richardson PG, Cavo M, et al. Proteasome Inhibitors in Multiple Myeloma: 10 Years Later. Blood. 2012; 120(5):947-959.
  8. Kyprolis® [package insert]. Thousand Oaks, CA: Amgen; 2016.
  9. Kortuem KM and Stewart AK. Carfilzomib. Blood. 2012; 121(6):893-897.

Source: Amgen.

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