Once-weekly carfilzomib dosing preferable for relapsed/refractory multiple myeloma

The once-weekly carfilzomib regimen of Kd70 mg/m² for relapsed or refractory multiple myeloma (RRMM) is more favourable than the twice-weekly Kd27 mg/m², as the former is associated with delayed symptom worsening and greater patient-reported convenience and satisfaction, according to a recent study.

The study used data from the open-label, phase III ARROW trial involving 478 adult RRMM patients who were previously treated with 2–3 prior lines of therapy, including a proteasome inhibitor and an immunomodulatory agent. Of the patients, 240 had been randomized to the once-weekly Kd70 mg/m² regimen and 238 to the twice-weekly Kd27 mg/m² regimen.

Researchers compared patient-reported convenience/satisfaction collected at cycle 2, day 1. They also administered European Organization for Research and Treatment of Cancer QOL Questionnaire (QLQ-C30), MM-module (QLQ-MY20) and EuroQoL-5 Dimensions-5 Levels (EQ-5D-5L) questionnaires at baseline and then every other cycle. Patient-reported outcome analyses included 469 patients.

Compared with twice-weekly, the once-weekly regimen conferred greater convenience (odds ratio [OR], 4.98; p<0.001) and satisfaction (OR, 2.41; p=0.059). Fewer patients in the once-weekly arm exhibited a clinically meaningful deterioration in QLQ-C30 Global Health Status/QOL (34.2 percent vs 40.3 percent).

Time from randomization to first deterioration was longer with the once-weekly vs twice-weekly regimen for the following outcomes: QLQ-C30 fatigue (hazard ratio [HR], 0.79; p=0.035), QLQ-MY20 disease symptoms (HR, 0.67; p=0.008), EQ-5D-5L index score (HR, 0.58; p=0.002) and EQ-5D-5L Visual Analog Scale (HR, 0.75; p=0.031).

The present data show that the once-weekly Kd70 mg/m² carfilzomib dose is superior and convenient, delivering more favourable health-related quality of life in RRMM patients compared with the commonly used Kd27 mg/m² dose, the researchers said. The once-weekly regimen is therefore positioned to be an important alternative in clinical practice.