Carfilzomib

Identification

Summary

Carfilzomibis a proteasome inhibitor used either alone or in conjunction with a chemotherapy regimen to treat patients with relapsed or refractory multiple myeloma.

Brand Names
Kyprolis
Generic Name
Carfilzomib
DrugBank Accession Number
DB08889
Background

Carfilzomib is an injectable antineoplastic agent (IV only). Chemically, it is a modified tetrapeptidyl epoxide and an analog of epoxomicin. It is also a selective proteasome inhibitor. FDA approved carfilzomib in July 2012 for the treatment of adults with relapsed or refractory multiple myeloma as monotherapy or combination therapy.3

Type
Small Molecule
Groups
Approved, Investigational
Structure
Weight
Average: 719.9099
Monoisotopic: 719.425799203
Chemical Formula
C40H57N5O7
Synonyms
  • Carfilzomib
External IDs
  • PR-171

Pharmacology

Indication

Carfilzomib is indicated for the treatment of adult patients with relapsed or refractory multiple myeloma who have received one to three lines of therapy in combination with lenalidomide and dexamethasone; or dexamethasone; or daratumumab and dexamethasone; or daratumumab and hyaluronidase-fihj and dexamethasone; or isatuximab and dexamethasone. It is also 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.3,4

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Associated Conditions
Contraindications & Blackbox Warnings
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Pharmacodynamics

Intravenous carfilzomib administration resulted in suppression of proteasome chymotrypsin-like activity when measured in blood 1 hour after the first dose. On Day 1 of Cycle 1, proteasome inhibition in peripheral blood mononuclear cells (PBMCs) ranged from 79% to 89% at 15 mg/m2, and from 82% to 83% at 20 mg/m2. In addition, carfilzomib administration resulted in inhibition of the LMP2 and MECL1 subunits of the immunoproteasome ranging from 26% to 32% and 41% to 49%, respectively, at 20 mg/m2. Proteasome inhibition was maintained for ≥ 48 hours following the first dose of carfilzomib for each week of dosing. Resistance against carfilzomib has been observed and although the mechanism has not been confirmed, it is thought that up-regulation of P-glycoprotein may be a contributing factor. Furthermore, studies suggest that carfilzomib is more potent than bortezomib.

Mechanism of action

Carfilzomib is made up of four modified peptides and acts as a proteasome inhibitor. Carfilzomib irreversibly and selectively binds to N-terminal threonine-containing active sites of the 20S proteasome, the proteolytic core particle within the 26S proteasome. This 20S core has 3 catalytic active sites: the chymotrypsin, trypsin, and caspase-like sites. Inhibition of the chymotrypsin-like site by carfilzomib (β5 and β5i subunits) is the most effective target in decreasing cellular proliferation, ultimately resulting in cell cycle arrest and apoptosis of cancerous cells. At higher doses, carfilzomib will inhibit the trypsin-and capase-like sites.

Target Actions Organism
AProteasome subunit beta type-5
inhibitor
Humans
AProteasome subunit beta type-8
inhibitor
Humans
AProteasome subunit beta type-1
inhibitor
Humans
AProteasome subunit beta type-9
inhibitor
Humans
AProteasome subunit beta type-2
inhibitor
Humans
AProteasome subunit beta type-10
inhibitor
Humans
Absorption

Cmax, single IV dose of 27 mg/m^2 = 4232 ng/mL; AUC, single IV dose of 27 mg/m^2 = 379 ng•hr/mL; Carfilzomib does not accumulation in the systemic. At doses between 20 and 36 mg/m2, there was a dose-dependent increase in exposure.

Volume of distribution

Vd, steady state, 20 mg/m^2 = 28 L

Protein binding

Over the concentration range of 0.4 - 4 micromolar, carfilzomib was 97% protein bound.

Metabolism

Carfilzomib was rapidly and extensively metabolized by the liver. The predominant metabolites were the peptide fragments and the diol of carfilzomib which suggests that the main metabolic pathways are peptidase cleavage and epoxide hydrolysis. The cytochrome P450 enzyme system is minimally involved in the metabolism of carfilzomib. All metabolites are inactive.

Route of elimination

Not Available

Half-life

Following intravenous administration of doses ≥ 15 mg/m^2, carfilzomib was rapidly cleared from the systemic circulation with a half-life of ≤ 1 hour on Day 1 of Cycle 1.

Clearance

Systemic clearance = 151 - 263 L/hour. As this value exceeds hepatic blood flow, it suggests that carfilozmib is cleared extrahepatically.

Adverse Effects
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Toxicity

Most commonly reported adverse reactions (incidence ≥ 30%) are fatigue, anemia, nausea, thrombocytopenia, dyspnea, diarrhea, and pyrexia. The two dose limiting toxicities are thrombocytopenia and febrile neutropenia. Maximum tolerate dose = 15 mg/m^2

Pathways
Not Available
Pharmacogenomic Effects/ADRsBrowse all" title="" id="snp-actions-info" class="drug-info-popup" href="javascript:void(0);">
Not Available

的相互作用

Drug InteractionsLearn More" title="" id="structured-interactions-info" class="drug-info-popup" href="javascript:void(0);">
This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.
Drug Interaction
Abatacept The risk or severity of adverse effects can be increased when Abatacept is combined with Carfilzomib.
Abciximab The risk or severity of bleeding can be increased when Abciximab is combined with Carfilzomib.
Abemaciclib The serum concentration of Abemaciclib can be increased when it is combined with Carfilzomib.
Abrocitinib The serum concentration of Carfilzomib can be increased when it is combined with Abrocitinib.
Acenocoumarol The risk or severity of bleeding can be increased when Acenocoumarol is combined with Carfilzomib.
Acetylsalicylic acid The risk or severity of bleeding can be increased when Acetylsalicylic acid is combined with Carfilzomib.
Adagrasib The serum concentration of Carfilzomib can be increased when it is combined with Adagrasib.
Adalimumab The risk or severity of adverse effects can be increased when Adalimumab is combined with Carfilzomib.
Adenovirus type 7 vaccine live The risk or severity of infection can be increased when Adenovirus type 7 vaccine live is combined with Carfilzomib.
Afatinib The serum concentration of Afatinib can be increased when it is combined with Carfilzomib.
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Food Interactions
No interactions found.

Products

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Brand Name Prescription Products
Name Dosage Strength Route Labeller Marketing Start Marketing End Region Image
Kyprolis Injection, powder, for solution 60 mg Intravenous Amgen Europe B.V. 2021-02-11 Not applicable EU flag
Kyprolis 粉,为解决方案 60 mg / vial Intravenous Amgen 2016-02-11 Not applicable Canada flag
Kyprolis Injection, powder, lyophilized, for solution 60 mg/30mL Intravenous Onyx Pharmaceuticals, Inc. 2012-07-20 Not applicable US flag
Kyprolis Injection, powder, for solution 30 mg Intravenous Amgen Europe B.V. 2021-02-11 Not applicable EU flag
Kyprolis 粉,为解决方案 30 mg / vial Intravenous Amgen 2017-02-06 Not applicable Canada flag
Kyprolis Injection, powder, lyophilized, for solution 10 mg/5mL Intravenous Onyx Pharmaceuticals, Inc. 2018-05-23 Not applicable US flag
Kyprolis Injection, powder, for solution 10 mg Intravenous Amgen Europe B.V. 2021-02-11 Not applicable EU flag
Kyprolis 粉,为解决方案 10 mg / vial Intravenous Amgen 2017-02-13 Not applicable Canada flag
Kyprolis Injection, powder, lyophilized, for solution 30 mg/15mL Intravenous Onyx Pharmaceuticals, Inc. 2016-07-15 Not applicable US flag

Categories

ATC Codes
L01XG02 — Carfilzomib
Drug Categories
Chemical TaxonomyProvided byClassyfire
Description
This compound belongs to the class of organic compounds known as oligopeptides. These are organic compounds containing a sequence of between three and ten alpha-amino acids joined by peptide bonds.
Kingdom
Organic compounds
Super Class
Organic acids and derivatives
Class
Carboxylic acids and derivatives
Sub Class
Amino acids, peptides, and analogues
Direct Parent
Oligopeptides
Alternative Parents
Phenylalanine and derivatives/Leucine and derivatives/N-acyl-alpha amino acids and derivatives/Alpha amino acid amides/Amphetamines and derivatives/N-acyl amines/Morpholines/Trialkylamines/Secondary carboxylic acid amides/Ketones
show 7 more
Substituents
Alpha-amino acid amide/Alpha-amino acid or derivatives/Alpha-oligopeptide/Amine/Amino acid or derivatives/Amphetamine or derivatives/Aromatic heteromonocyclic compound/Azacycle/Benzenoid/Carbonyl group
show 27 more
Molecular Framework
Aromatic heteromonocyclic compounds
External Descriptors
epoxide, tetrapeptide, morpholines (CHEBI: 65347)
Affected organisms
  • Humans and other mammals

Chemical Identifiers

UNII
72X6E3J5AR
CAS number
868540-17-4
InChI Key
BLMPQMFVWMYDKT-NZTKNTHTSA-N
InChI
InChI=1S/C40H57N5O7/c1-27(2)22-32(36(47)40(5)26-52-40)42-39(50)34(24-30-14-10-7-11-15-30)44-38(49)33(23-28(3)4)43-37(48)31(17-16-29-12-8-6-9-13-29)41-35(46)25-45-18-20-51-21-19-45/h6-15,27-28,31-34H,16-26H2,1-5H3,(H,41,46)(H,42,50)(H,43,48)(H,44,49)/t31-,32-,33-,34-,40+/m0/s1
IUPAC Name
(2S)-4-methyl-N-[(1S)-1-{[(2S)-4-methyl-1-[(2R)-2-methyloxiran-2-yl]-1-oxopentan-2-yl]carbamoyl}-2-phenylethyl]-2-[(2S)-2-[2-(morpholin-4-yl)acetamido]-4-phenylbutanamido]pentanamide
SMILES
CC(C)C[C@H](NC(=O)[C@H](CCC1=CC=CC=C1)NC(=O)CN1CCOCC1)C(=O)N[C@@H](CC1=CC=CC=C1)C(=O)N[C@@H](CC(C)C)C(=O)[C@@]1(C)CO1

References

一般引用
  1. Kortuem KM, Stewart AK: Carfilzomib. Blood. 2013 Feb 7;121(6):893-7. doi: 10.1182/blood-2012-10-459883. [Article]
  2. Kuhn DJ, Chen Q, Voorhees PM, Strader JS, Shenk KD, Sun CM, Demo SD, Bennett MK, van Leeuwen FW, Chanan-Khan AA, Orlowski RZ: Potent activity of carfilzomib, a novel, irreversible inhibitor of the ubiquitin-proteasome pathway, against preclinical models of multiple myeloma. Blood. 2007 Nov 1;110(9):3281-90. Epub 2007 Jun 25. [Article]
  3. FDA Approved Drug Products: KYPROLIS (carfilzomib) for injection, for intravenous use [Link]
  4. FDA Approved Drug Products: KYPROLIS (carfilzomib) for injection, for intravenous use 2022 [Link]
KEGG Drug
D08880
PubChem Compound
11556711
PubChem Substance
175427135
ChemSpider
9731489
BindingDB
50277889
RxNav
1302966
ChEBI
65347
ChEMBL
CHEMBL451887
ZINC
ZINC000049841054
PharmGKB
PA166165203
RxList
RxList Drug Page
Drugs.com
Drugs.com Drug Page
Wikipedia
Carfilzomib
FDA label
Download (310 KB)

Clinical Trials

Clinical TrialsLearn More" title="" id="clinical-trials-info" class="drug-info-popup" href="javascript:void(0);">
Phase Status Purpose Conditions Count
4 Active Not Recruiting Treatment Relapsed/Refractory Multiple Myeloma (RRMM) 1
4 Completed Treatment Relapsed/Refractory Multiple Myeloma (RRMM) 1
3 Active Not Recruiting Treatment Multiple Myeloma (MM) 5
3 Active Not Recruiting Treatment Newly Diagnosed Multiple Myeloma 2
3 Completed Treatment Multiple Myeloma (MM) 4
3 Completed Treatment Multiple Myeloma in Relapse 1
3 Completed Treatment Multiple Myeloma in Relapse/Refractory Multiple Myeloma 1
3 Completed Treatment Relapsed/Refractory Multiple Myeloma (RRMM) 2
3 Recruiting Treatment Multiple Myeloma (MM) 4
3 Recruiting Treatment Multiple Myeloma (MM)/New Diagnosis Tumor 1

Pharmacoeconomics

Manufacturers
Not Available
Packagers
Not Available
Dosage Forms
Form Route Strength
Injection, powder, for solution Intravenous 10 mg
Injection, powder, for solution Intravenous 30 mg
Injection, powder, lyophilized, for solution Intravenous 10 mg/5mL
Injection, powder, lyophilized, for solution Intravenous 30 mg/15mL
Injection, powder, lyophilized, for solution Intravenous 60 mg/30mL
粉,为解决方案 Intravenous 10 mg / vial
粉,为解决方案 Intravenous 30 mg / vial
粉,为解决方案 Intravenous 60 mg / vial
粉,为解决方案 Intravenous; Parenteral 10 MG
粉,为解决方案 Intravenous; Parenteral 30 MG
粉,为解决方案 Intravenous; Parenteral 60 MG
Injection, powder, for solution Intravenous 60 mg/1vial
粉,为解决方案 60 mg/mg
Injection, solution Intravenous 60 mg
Injection, powder, lyophilized, for solution Intravenous 30 mg
Injection, powder, lyophilized, for solution Intravenous 60 mg
Powder Intravenous 60 mg
Injection, powder, for solution Intravenous 60 mg
Prices
Not Available
Patents
Patent Number Pediatric Extension Approved Expires (estimated) Region
US7491704 No 2009-02-17 2025-04-14 US flag
US8129346 No 2012-03-06 2026-12-25 US flag
US8207127 No 2012-06-26 2025-04-14 US flag
US8207125 No 2012-06-26 2025-04-14 US flag
US7417042 No 2008-08-26 2026-06-07 US flag
US8207126 No 2012-06-26 2025-04-14 US flag
US7232818 No 2007-06-19 2025-04-14 US flag
US8207297 No 2012-06-26 2025-04-14 US flag
US7737112 No 2010-06-15 2027-12-07 US flag
US9493582 No 2016-11-15 2033-02-27 US flag
US9511109 No 2016-12-06 2029-10-21 US flag
USRE47954 No 2020-04-21 2029-10-21 US flag

Properties

State
Solid
Experimental Properties
Property Value Source
water solubility Insoluble FDA
pKa 3.5 FDA
Predicted Properties
Property Value Source
Water Solubility 0.00484 mg/mL ALOGPS
logP 3.21 ALOGPS
logP 4.2 Chemaxon
logS -5.2 ALOGPS
pKa (Strongest Acidic) 11.91 Chemaxon
pKa (Strongest Basic) 4.96 Chemaxon
Physiological Charge 0 Chemaxon
Hydrogen Acceptor Count 8 Chemaxon
Hydrogen Donor Count 4 Chemaxon
Polar Surface Area 158.47 Å2 Chemaxon
Rotatable Bond Count 20 Chemaxon
Refractivity 198.02 m3·mol-1 Chemaxon
Polarizability 79.45 Å3 Chemaxon
Number of Rings 4 Chemaxon
Bioavailability 0 Chemaxon
Rule of Five No Chemaxon
Ghose Filter No Chemaxon
Veber's Rule No Chemaxon
MDDR-like规则 Yes Chemaxon
Predicted ADMET Features
Property Value Probability
Human Intestinal Absorption + 0.7982
Blood Brain Barrier - 0.8941
Caco-2 permeable - 0.6924
P-glycoprotein substrate Substrate 0.9378
P-glycoprotein inhibitor I Inhibitor 0.8224
P-glycoprotein inhibitor II Non-inhibitor 0.9045
Renal organic cation transporter Non-inhibitor 0.8642
CYP450 2C9 substrate Non-substrate 0.8812
CYP450 2D6 substrate Non-substrate 0.7587
CYP450 3A4 substrate Substrate 0.6641
CYP450 1A2 substrate Non-inhibitor 0.9031
CYP450 2C9 inhibitor Non-inhibitor 0.8546
CYP450 2D6 inhibitor Non-inhibitor 0.7152
CYP450 2C19 inhibitor Non-inhibitor 0.6665
CYP450 3A4 inhibitor Inhibitor 0.6532
CYP450 inhibitory promiscuity Low CYP Inhibitory Promiscuity 0.9676
Ames test Non AMES toxic 0.7119
Carcinogenicity Non-carcinogens 0.8431
Biodegradation Not ready biodegradable 0.9942
Rat acute toxicity 2.6381 LD50, mol/kg Not applicable
hERG inhibition (predictor I) Weak inhibitor 0.9831
hERG inhibition (predictor II) Non-inhibitor 0.6044
ADMET data is predicted usingadmetSAR, a free tool for evaluating chemical ADMET properties. (23092397)

Spectra

Mass Spec (NIST)
Not Available
Spectra
Spectrum Spectrum Type Splash Key
Predicted MS/MS Spectrum - 10V, Positive (Annotated) Predicted LC-MS/MS Not Available
Predicted MS/MS Spectrum - 20V, Positive (Annotated) Predicted LC-MS/MS Not Available
Predicted MS/MS Spectrum - 40V, Positive (Annotated) Predicted LC-MS/MS Not Available
Predicted MS/MS Spectrum - 10V, Negative (Annotated) Predicted LC-MS/MS Not Available
Predicted MS/MS Spectrum - 20V, Negative (Annotated) Predicted LC-MS/MS Not Available
Predicted MS/MS Spectrum - 40V, Negative (Annotated) Predicted LC-MS/MS Not Available

Targets

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insights and accelerate drug research.
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Kind
Protein
Organism
Humans
Pharmacological action
Yes
Actions
Inhibitor
General Function
Threonine-type endopeptidase activity
Specific Function
The proteasome is a multicatalytic proteinase complex which is characterized by its ability to cleave peptides with Arg, Phe, Tyr, Leu, and Glu adjacent to the leaving group at neutral or slightly ...
Gene Name
PSMB5
Uniprot ID
P28074
Uniprot Name
Proteasome subunit beta type-5
分子量
28480.01 Da
References
  1. Kortuem KM, Stewart AK: Carfilzomib. Blood. 2013 Feb 7;121(6):893-7. doi: 10.1182/blood-2012-10-459883. [Article]
Kind
Protein
Organism
Humans
Pharmacological action
Yes
Actions
Inhibitor
General Function
Threonine-type endopeptidase activity
Specific Function
The proteasome is a multicatalytic proteinase complex which is characterized by its ability to cleave peptides with Arg, Phe, Tyr, Leu, and Glu adjacent to the leaving group at neutral or slightly ...
Gene Name
PSMB8
Uniprot ID
P28062
Uniprot Name
Proteasome subunit beta type-8
分子量
30354.035 Da
References
  1. Kuhn DJ, Chen Q, Voorhees PM, Strader JS, Shenk KD, Sun CM, Demo SD, Bennett MK, van Leeuwen FW, Chanan-Khan AA, Orlowski RZ: Potent activity of carfilzomib, a novel, irreversible inhibitor of the ubiquitin-proteasome pathway, against preclinical models of multiple myeloma. Blood. 2007 Nov 1;110(9):3281-90. Epub 2007 Jun 25. [Article]
Kind
Protein
Organism
Humans
Pharmacological action
Yes
Actions
Inhibitor
General Function
Threonine-type endopeptidase activity
Specific Function
The proteasome is a multicatalytic proteinase complex which is characterized by its ability to cleave peptides with Arg, Phe, Tyr, Leu, and Glu adjacent to the leaving group at neutral or slightly ...
Gene Name
PSMB1
Uniprot ID
P20618
Uniprot Name
Proteasome subunit beta type-1
分子量
26489.09 Da
References
  1. Kuhn DJ, Chen Q, Voorhees PM, Strader JS, Shenk KD, Sun CM, Demo SD, Bennett MK, van Leeuwen FW, Chanan-Khan AA, Orlowski RZ: Potent activity of carfilzomib, a novel, irreversible inhibitor of the ubiquitin-proteasome pathway, against preclinical models of multiple myeloma. Blood. 2007 Nov 1;110(9):3281-90. Epub 2007 Jun 25. [Article]
Kind
Protein
Organism
Humans
Pharmacological action
Yes
Actions
Inhibitor
General Function
Threonine-type endopeptidase activity
Specific Function
The proteasome is a multicatalytic proteinase complex which is characterized by its ability to cleave peptides with Arg, Phe, Tyr, Leu, and Glu adjacent to the leaving group at neutral or slightly ...
Gene Name
PSMB9
Uniprot ID
P28065
Uniprot Name
Proteasome subunit beta type-9
分子量
23264.1 Da
References
  1. Kuhn DJ, Chen Q, Voorhees PM, Strader JS, Shenk KD, Sun CM, Demo SD, Bennett MK, van Leeuwen FW, Chanan-Khan AA, Orlowski RZ: Potent activity of carfilzomib, a novel, irreversible inhibitor of the ubiquitin-proteasome pathway, against preclinical models of multiple myeloma. Blood. 2007 Nov 1;110(9):3281-90. Epub 2007 Jun 25. [Article]
Kind
Protein
Organism
Humans
Pharmacological action
Yes
Actions
Inhibitor
General Function
Threonine-type endopeptidase activity
Specific Function
The proteasome is a multicatalytic proteinase complex which is characterized by its ability to cleave peptides with Arg, Phe, Tyr, Leu, and Glu adjacent to the leaving group at neutral or slightly ...
Gene Name
PSMB2
Uniprot ID
P49721
Uniprot Name
Proteasome subunit beta type-2
分子量
22836.02 Da
References
  1. Kuhn DJ, Chen Q, Voorhees PM, Strader JS, Shenk KD, Sun CM, Demo SD, Bennett MK, van Leeuwen FW, Chanan-Khan AA, Orlowski RZ: Potent activity of carfilzomib, a novel, irreversible inhibitor of the ubiquitin-proteasome pathway, against preclinical models of multiple myeloma. Blood. 2007 Nov 1;110(9):3281-90. Epub 2007 Jun 25. [Article]
Kind
Protein
Organism
Humans
Pharmacological action
Yes
Actions
Inhibitor
General Function
Threonine-type endopeptidase activity
Specific Function
The proteasome is a multicatalytic proteinase complex which is characterized by its ability to cleave peptides with Arg, Phe, Tyr, Leu, and Glu adjacent to the leaving group at neutral or slightly ...
Gene Name
PSMB10
Uniprot ID
P40306
Uniprot Name
Proteasome subunit beta type-10
分子量
28936.08 Da
References
  1. Kuhn DJ, Chen Q, Voorhees PM, Strader JS, Shenk KD, Sun CM, Demo SD, Bennett MK, van Leeuwen FW, Chanan-Khan AA, Orlowski RZ: Potent activity of carfilzomib, a novel, irreversible inhibitor of the ubiquitin-proteasome pathway, against preclinical models of multiple myeloma. Blood. 2007 Nov 1;110(9):3281-90. Epub 2007 Jun 25. [Article]

Transporters

Kind
Protein
Organism
Humans
Pharmacological action
Unknown
Actions
Substrate
Inhibitor
General Function
Xenobiotic-transporting atpase activity
Specific Function
Energy-dependent efflux pump responsible for decreased drug accumulation in multidrug-resistant cells.
Gene Name
ABCB1
Uniprot ID
P08183
Uniprot Name
Multidrug resistance protein 1
分子量
141477.255 Da

Drug created at May 29, 2013 22:03 / Updated at April 30, 2023 03:04