Relapsed/Refractory Patients:

Perifosine (KRX-0401)

What is Perifosine?

Perifosine, also known as KRX-0401, is an oral anticancer agent being developed by Keryx Biopharmaceuticals. Perifosine affects tumor cell growth and survival. In particular, it inhibits the Akt pathway, which is involved in the development of many types of cancer.

What do we know about Perifosine’s activity in myeloma?

Perifosine has been shown to kill myeloma cells in the laboratory and in animal models, including those that are resistant to conventional anti-myeloma drugs. In addition, in the laboratory, perifosine acts synergistically with other agents, including dexamethasone, doxorubicin, melphalan, and Velcade® (bortezomib).

Perifosine has been studied in combination with dexamethasone, Revlimid® (lenalidomide), and Velcade in clinical trials.

• In a Phase I trial facilitated by the Multiple Myeloma Research Consortium (MMRC), perifosine in combination with Revlimid and dexamethasone had manageable side effects and showed activity in relapsed or refractory myeloma.
• Perifosine, alone and in combination with dexamethasone, showed activity against relapsed/refractory myeloma in a Phase II study (n=67), with preliminary results showing an overall response rate of 35%.
• The combination of perifosine and Velcade, with or without dexamethasone, showed promising activity in a Phase II study involving patients with relapsed/refractory myeloma, all of whom had previously received Velcade therapy.
  • The combination was active in patients (n=20) who had relapsed on Velcade (ie, they responded, then progressed more than 2 months following completion of treatment), with 10% achieving a complete response (CR) or near-CR and 35% a partial response.
  • The combination was also active in patients (n=53) who were refractory to Velcade (ie, they progressed on or within 2 months of treatment), with 2% achieving a CR/near-CR and 11% a partial response.
  • The median length of time before myeloma progressed (progression-free survival) was 6.4 months for all evaluable patients and overall survival was 25 months.
  • Dose adjustments could be made to manage side effects. The most common adverse events included gastrointestinal effects, fatigue, muscle/bone pain, and upper respiratory infection. The most common severe adverse events included low blood cell counts, pneumonia, and muscle/bone pain.

How is Perifosine currently being studied in myeloma?

A Phase III trial of perifosine plus Velcade-dexamethasone is underway. The study is enrolling patients with myeloma who have relapsed on a prior Velcade treatment regimen. Patients must have received at least one but not more than four prior anti-myeloma therapies and can have refractory disease, but must not be refractory to any Velcade-containing regimen.

Click here to go to the MMRF Clinical Trial Matching Service.