A trial comparing carfilzomib once a week with carfilzomib twice a week for myeloma (ARROW)

Cancer type:

Myeloma

Status:

Results

Phase:

Phase 3

This trial looked at different ways to have carfilzomib for people with myeloma that had come back or treatment had stopped working.

The trial was open for people to join between 2015 and 2016. The research team published the results in 2018.

More about this trial

Carfilzomib (Kyprolis) is a type of targeted cancer treatment called a proteasome inhibitor. It works by stopping the breakdown of abnormal proteins in the cancer cell. This causes the cancer cell to die.

When this trial was done, we already knew from research that carfilzomib can be a useful treatment for people with myeloma. People often had carfilzomib twice a week.

The people taking part in this trial either had:

carfilzomib twice a week as usual
a higher dose of carfilzomib once a week

The main aim of the trial was to find out if it is better to have carfilzomib once a week or twice a week.

Summary of results

The research team found that it is better to have carfilzomib once a week than twice a week.

Trial design
Everyone taking part in this trial had already had treatment for myeloma. But either the treatment hadn’t worked (refractory myeloma), or their myeloma had come back again (relapsed).

478 people took part and were put into 1 of 2 groups at random:

240 had a higher dose of carfilzomib once a week
238 had a lower dose of carfilzomib twice a week

ARROW trial diagram

Results
The research team looked at how many people’s myeloma had started to get worse, and found it was:

126 people who’d had treatment once a week
148 people who’d had treatment twice a week

When they compared how long it was before the myeloma started to get worse, they found it was:

11.2 months for those who had treatment once a week
7.6 months for those who had treatment twice a week

ARROW trial graph

They also looked at how many people had died. It was fewer people who’d had treatment once a week:

58 people who’d had treatment once a week
68 people who’d had treatment twice a week

Side effects
Most people who took part had at least 1 side effect. Some were mild or didn’t last very long, but a few were more severe.

The people who had a higher dose of carfilzomib once a week had a few more side effects. The most common more serious side effects were a drop in blood cells, lung infection (pneumonia) and increased blood pressure.

A few people in each group decided to stop treatment because of side effects they were having:

30 people who had treatment once a week
27 people who had treatment twice a week

Conclusion
The research team concluded that a higher dose of carfilzomib once a week caused a few more side effects but worked better. This is compared to a lower dose twice a week.

They suggest it is looked at in other trials, possibly in combination with other treatments.

More detailed information
There is more information about this research in the reference below.

Once weekly versus twice weekly carfilzomib dosing in patients with relapsed and refractory multiple myeloma (A.R.R.O.W.): interim analysis results of a randomised, phase 3 study
Philippe Moreau and others
The Lancet, 2018. Volume 19, issue 7, pages 953-964.

Please note, the information we link to here is not in plain English. It has been written for healthcare professionals and researchers.

Where this information comes from
We have based this summary on information from the research team. The information they sent us has been reviewed by independent specialists (peer reviewed Open a glossary item ) and published in a medical journal. The figures we quote above were provided by the trial team who did the research. We have not analysed the data ourselves.