Carfilzomib in Resistant Myeloma: Once Weekly Versus Twice Weekly
Posted: Thursday, July 12, 2018
Not only does once-weekly carfilzomib plus dexamethasone seem to result in longer progression-free survival than the same regimen given twice weekly, but it offers patients with relapsed and refractory multiple myeloma a more convenient therapeutic option, which may lead to better adherence, according to the phase III ARROW trial results. Philippe Moreau, MD, of the University Hospital Hotel-Dieu, Nantes, France, and colleagues published their findings inThe Lancet Oncology. Moreover, no additional or new toxic effects were reported with the less-frequent regimen.
A total of 478 patients from 118 sites in North America, Europe, and Asia were included in the efficacy analyses. From September 2015 to August 2016, half of them received carfilzomib at 70 mg/m2once weekly, and the other half received carfilzomib at 27 mg/m2twice weekly in 28-day cycles. All patients, who also were given dexamethasone, had to have received two or three prior treatments.
At a median follow-up of 1 year, those in the once-weekly group had a longer median progression-free survival than did those in the twice-weekly group (11.2 months vs. 7.6 months). In all subgroups examined except for those with standard-risk cytogenetics, hazard ratios favored the once-weekly treatment. In addition, the overall response rate was better with once-weekly versus twice-weekly treatment (62.9% vs. 40.8%, P< .001). At the time of analysis, overall survival data were not mature.
As for toxicity, the incidence of grade 3 or higher adverse events was higher with once-weekly than twice-weekly treatment (68% vs. 62%). Of note, fewer patients in the once-weekly group had grade 3 or worse cardiac failure than in the twice-weekly group. At the time of data cutoff, 58 deaths were reported in the once-weekly group and 68 deaths, in the twice-weekly group.
