Amgen announced the initiation of the ARROW trial(1), a global Phase 3 study evaluating the benefit of Kyprolis (carfilzomib) for Injection administered once-weekly with dexamethasone versus the current U.S. Food and Drug Administration (FDA) approved twice-weekly administration schedule in patients with relapsed and refractory multiple myeloma who have received prior treatment with bortezomib and an immunomodulatory agent (IMiD).
Multiple myeloma is the second most common hematologic cancer and results from an abnormality of plasma cells, usually in the bone marrow. Worldwide, nearly 230,000 people are living with multiple myeloma and approximately 114,000 new cases are diagnosed annually.(3) In the U.S., there are nearly 96,000 people living with, or in remission from, multiple myeloma. The estimated number of new cases of multiple myeloma in 2014 was more than 24,000 and the estimated number of deaths was 11,090.(4) In Europe, approximately 89,000 people are living with the disease and in 2012 there was an estimated 39,000 newly diagnosed cases and 24,000 deaths.
The new ARROW trial was initiated based on results from the Phase 1/2 CHAMPION study, which were presented at the 51st Annual Meeting of the American Society of Clinical Oncology (ASCO).(2)
Results from the Phase 1 and 2 portions of CHAMPION were presented for 104 patients (Phase 1, n=15; Phase 2, n=89) with relapsed or refractory multiple myeloma who had received one to three prior treatment regimens at the determined maximum tolerated dose (MTD) of 20/70 mg/m2. In the Phase 2 portion of the study, the overall response rate (ORR; defined as the percentage of patients achieving a partial response or better) was 77 percent.
The clinical benefit rate (CBR; defined as the percentage of patients with minimal response or better) was 84 percent; the median time to response for patients who achieved a partial response or better was 1.6 months (range, 0.7-7.2); Kaplan-Meier median duration of response (DOR) was 15 months (95 percent CI 9-not estimable); and the Kaplan-Meier median progression-free survival (PFS) was 10.6 months (95 percent CI 9.0-16.1).
"The results from the CHAMPION Phase 1/2 study form the basis of the Phase 3 ARROW study with the goal of potentially providing patients and physicians greater convenience with a once-weekly dosing schedule of Kyprolis," said Sean E. Harper, M.D., executive vice president of Research and Development at Amgen. "The initiation of this trial underscores our commitment to addressing the needs of patients with multiple myeloma through the entire treatment continuum."
The most common hematologic treatment-emergent adverse events (AEs) of any grade were anemia (24 percent), thrombocytopenia (22 percent) and neutropenia (8 percent). The most common non-hematologic treatment-emergent AEs of any grade were fatigue (52 percent), nausea (35 percent), headache and diarrhea (31 percent each). The most commonly occurring grade ≥3 hematologic treatment-emergent AEs were thrombocytopenia (6 percent), anemia (5 percent) and neutropenia (4 percent). The most common non-hematologic grade ≥3 treatment-emergent AEs were fatigue (11 percent), pneumonia (7 percent), acute renal failure and hypertension (6 percent each). Adverse events grade ≥3 included cardiac failure (2 percent) and peripheral neuropathy (1 percent).
A total of 36 patients (35 percent) had at least one serious AE. Sixteen patients (15 percent) treated at the MTD had at least one carfilzomib dose reduction due to AEs, and 10 patients (10 percent) discontinued study treatment due to AEs. Ten patients (10 percent) discontinued treatment due to investigator's discretion, 12 patients (12 percent) discontinued due to patient decision and 34 patients (33 percent) discontinued due to progressive disease. A total of five patients died during the study, all of which were in the Phase 2 portion of the study: one patient each had cause of death reported as cardiopulmonary arrest, pneumonia, disease progression, acute respiratory distress syndrome and acute kidney injury.
Notes:
(1) The ARROW (RAndomized, Open-label, Phase 3 Study in Subjects with Relapsed and Refractory Multiple Myeloma Receiving Carfilzomib in Combination with Dexamethasone, Comparing Once-Weekly versus Twice-weekly Carfilzomib Dosing) trial is evaluating approximately 460 patients with relapsed and refractory multiple myeloma who have received at least two but no more than three prior therapies, including bortezomib and an IMiD. Those included in the study will be randomized to receive once-weekly Kyprolis (20 mg/m2 on day 1 of cycle 1, 70 mg/m2 on days 8 and 15 of cycle 1 and 70 mg/m2 on days 1, 8 and 15 of subsequent cycles) with dexamethasone (40 mg) versus twice-weekly Kyprolis (20 mg/m2 on days 1 and 2 of cycle 1, 27 mg/m2 on days 8, 9, 15 and 16 of cycle 1 and 27 mg/m2 on days 1, 2, 8, 9, 15 and 16 of subsequent cycles) with dexamethasone (40 mg). The primary endpoint of the trial is ORR, defined as the proportion of subjects achieving a best overall response of partial response, very good partial response, complete response or stringent complete response based on the International Myeloma Working Group Uniform Response Criteria. Secondary endpoints include PFS, overall survival and safety and tolerability. The trial is being conducted in approximately 100 sites worldwide. For more information about this trial, please visit www.clinicaltrials.gov under trial identification number NCT02412878.
(2) The CHAMPION (Community Harmonized Assessment of Myeloma Patients via an Integrated Oncology Network) trial is a Phase 1/2, multicenter, single-arm, non-randomized, open-label and dose-escalation study of weekly Kyprolis with dexamethasone for patients with relapsed or refractory multiple myeloma. The primary objective of the Phase 1 portion of the study was to determine the MTD of once-weekly Kyprolis with dexamethasone. The primary objective of the Phase 2 portion of the study was to determine the ORR. Secondary endpoints were to evaluate the CBR, PFS, time to progression and DOR. Patients who received one to three prior treatment regimens were eligible to enroll. The last patient was enrolled in September 2014, and the data cutoff date for analyses presented at ASCO was May 1, 2015. A total of 48 percent of enrolled patients were bortezomib-refractory, 28 percent were lenalidomide-refractory and 16 percent were refractory to both bortezomib and lenalidomide. In the Phase 1 portion, patients received Kyprolis as a 30-minute intravenous (IV) infusion on days 1, 8 and 15 of a 28-day cycle using a standard 3+3 dose-escalation scheme. Patients received Kyprolis at 20 mg/m2 on day 1 of cycle 1. Subsequent doses started at 45 mg/m2 and were escalated to 56, 70 or 88 mg/m2 beginning on day 8 of cycle 1 until the MTD of 20/70 mg/m2 was reached for use in the Phase 2 portion. Patients received dexamethasone 40 mg (IV or oral) on days 1, 8, 15 and 22 of cycles 1–8; dexamethasone was omitted on day 22 beginning in cycle 9. Treatment was administered until disease progression or unacceptable toxicity was observed.
(3) International Agency for Research on Cancer, GLOBOCAN 2012 database. Available at http://globocan.iarc.fr/. Accessed May 2015.
(4) Leukemia & Lymphoma Society. Facts 2014-2015. Available at: http://www.lls.org/content/nationalcontent/resourcecenter/freeeducationm.... Accessed May 2015.