Once-weekly Versus Twice-weekly Carfilzomib in Combination With Dexamethasone in Adults With Relapsed and Refractory Multiple Myeloma

NCT ID: NCT02412878

Last Updated: 2022-09-23

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

478 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-09-09

Study Completion Date

2019-01-07

Brief Summary

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The purpose of the study is to compare the progression-free survival (PFS) of once-weekly carfilzomib dosing in combination with dexamethasone to twice-weekly carfilzomib dosing in combination with dexamethasone in adults with relapsed and refractory multiple myeloma, previously treated with bortezomib and an immunomodulatory agent (IMiD).

Detailed Description

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Conditions

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Multiple Myeloma

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Once-weekly Carfilzomib 20/70 mg/m² + Dexamethasone

Participants received carfilzomib administered by intravenous (IV) infusion on days 1, 8, and 15 of each 28-day cycle (20 mg/m² on day 1 of cycle 1 and 70 mg/m² thereafter).

Participants also received 40 mg dexamethasone IV or orally on days 1, 8, 15 and 22 for the first 8 cycles; starting with cycle 9, dexamethasone was administered only on days 1, 8, and 15.

Group Type EXPERIMENTAL

Carfilzomib

Intervention Type DRUG

Carfilzomib was administered as an IV infusion

Dexamethasone

Intervention Type DRUG

Commercially available dexamethasone was obtained by the investigational site.

Twice-weekly Carfilzomib 20/27 mg/m² + Dexamethasone

Participants received carfilzomib administered by IV infusion on days 1, 2, 8, 9, 15, and 16 of each 28-day cycle (20 mg/m² on days 1 and 2 of cycle 1 and 27 mg/m² thereafter).

Participants also received 40 mg dexamethasone IV or orally on days 1, 8, 15 and 22 for the first 8 cycles; starting with cycle 9, dexamethasone was administered only on days 1, 8, and 15.

Group Type EXPERIMENTAL

Carfilzomib

Intervention Type DRUG

Carfilzomib was administered as an IV infusion

Dexamethasone

Intervention Type DRUG

Commercially available dexamethasone was obtained by the investigational site.

Interventions

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Carfilzomib

Carfilzomib was administered as an IV infusion

Intervention Type DRUG

Dexamethasone

Commercially available dexamethasone was obtained by the investigational site.

Intervention Type DRUG

Other Intervention Names

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PR-171 PR171 Kyprolis® (carfilzomib) for Injection

Eligibility Criteria

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Inclusion Criteria

1. Relapsed multiple myeloma
2. Refractory multiple myeloma defined as meeting 1 or more of the following:

* Nonresponsive to most recent therapy (stable disease only or PD while on treatment), or
* Disease progression within 60 days of discontinuation from most recent therapy
3. At least 2 but no more than 3 prior therapies for multiple myeloma
4. Prior exposure to an immunomodulatory agent (IMiD)
5. Prior exposure to a proteasome inhibitor (PI)
6. Documented response of at least partial response (PR) to 1 line of prior therapy
7. Measurable disease with at least 1 of the following assessed within the 21 days prior to randomization:

* Serum M-protein ≥ 0.5 g/dL
* Urine M-protein ≥ 200 mg/24 hours
* In subjects without detectable serum or urine M-protein, serum free light chain (SFLC) \> 100 mg/L (involved light chain) and an abnormal serum kappa lambda ratio
8. Eastern Cooperative Oncology Group Performance Status (ECOG PS) of 0 or 1
9. Left ventricular ejection fraction (LVEF) ≥ 40% within the 21 days prior to randomization
10. Adequate organ and bone marrow function within the 21 days prior to randomization defined by:

* Bilirubin \< 1.5 times the upper limit of normal (ULN)
* Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) \< 3 times the ULN
* Absolute neutrophil count (ANC) ≥ 1000/mm³ (screening ANC should be independent of growth factor support for ≥ 1 week)
* Hemoglobin ≥ 8.0 g/dL (Use of erythropoietic stimulating factors and red blood cell \[RBC\] transfusion per institutional guidelines is allowed, however the most recent RBC transfusion may not have been done within 7 days prior to obtaining screening hemoglobin.)
* Platelet count ≥ 50,000/mm³ (≥ 30,000/mm³ if myeloma involvement in the bone marrow is \> 50%. Subjects should not have received platelet transfusions for at least 1 week prior to obtaining the screening platelet count.)
* Calculated or measured creatinine clearance (CrCl) of ≥ 30 mL/min

Exclusion Criteria

1. Waldenström macroglobulinemia
2. Multiple myeloma of Immunoglobin M (IgM) subtype
3. POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes)
4. Plasma cell leukemia (\> 2.0 × 10⁹/L circulating plasma cells by standard differential)
5. Myelodysplastic syndrome
6. Second malignancy within the past 5 years except:

* Adequately treated basal cell or squamous cell skin cancer
* Carcinoma in situ of the cervix
* Prostate cancer \< Gleason score 6 with stable prostate-specific antigen (PSA) over 12 months
* Ductal breast carcinoma in situ with full surgical resection (i.e., negative margins)
* Treated medullary or papillary thyroid cancer
* Similar condition with an expectation of \> 95% five-year disease-free survival
7. History of or current amyloidosis
8. Cytotoxic chemotherapy within the 28 days prior to randomization
9. Immunotherapy within the 21 days prior to randomization
10. Glucocorticoid therapy within the 14 days prior to randomization that exceeds a cumulative dose of 160 mg of dexamethasone or 1000 mg prednisone
11. Radiation therapy:

* Focal therapy within the 7 days prior to randomization
* Extended field therapy within the 21 days prior to randomization
12. Prior treatment with either carfilzomib or oprozomib
13. Known history of allergy to Captisol (a cyclodextrin derivative used to solubilize carfilzomib)
14. Contraindication to dexamethasone or any of the required concomitant drugs or supportive treatments, including hypersensitivity to antiviral drugs, or intolerance to hydration due to pre-existing pulmonary or cardiac impairment
15. Active congestive heart failure (New York Heart Association \[NYHA\] Class III or IV), symptomatic ischemia, conduction abnormalities uncontrolled by conventional intervention, acute diffuse infiltrative pulmonary disease, pericardial disease, or myocardial infarction within 6 months prior to enrollment
16. Active infection within the 14 days prior to randomization requiring systemic antibiotics
17. Pleural effusions requiring thoracentesis within the 14 days prior to randomization
18. Ascites requiring paracentesis within the 14 days prior to randomization
19. Ongoing graft-versus-host disease
20. Uncontrolled hypertension or uncontrolled diabetes despite medication
21. Significant neuropathy (≥ Grade 3) within the 14 days prior to randomization
22. Known cirrhosis
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Amgen

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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MD

Role: STUDY_DIRECTOR

Amgen

Locations

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Research Site

Scottsdale, Arizona, United States

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Mayo Clinic

Scottsdale, Arizona, United States

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Bethesda, Maryland, United States

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Center for Cancer and Blood Disorders

Bethesda, Maryland, United States

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Rockville, Maryland, United States

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Maryland Oncology Hematology, P.A

Rockville, Maryland, United States

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Hackensack, New Jersey, United States

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John Theurer Cancer Center at Hackensack University Medical Center

Hackensack, New Jersey, United States

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New York, New York, United States

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Pittsburgh, Pennsylvania, United States

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Tyler, Texas, United States

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Blood and Cancer Center of East Texas

Tyler, Texas, United States

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Darlinghurst, New South Wales, Australia

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Tweed Heads, New South Wales, Australia

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Waratah, New South Wales, Australia

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Box Hill, Victoria, Australia

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Antwerp, , Belgium

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Bruges, , Belgium

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Brussels, , Belgium

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Brussels, , Belgium

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Ghent, , Belgium

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Leuven, , Belgium

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Calgary, Alberta, Canada

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Kelowna, British Columbia, Canada

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Vancouver, British Columbia, Canada

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St. John's, Newfoundland and Labrador, Canada

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Halifax, Nova Scotia, Canada

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Ottawa, Ontario, Canada

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Toronto, Ontario, Canada

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Montreal, Quebec, Canada

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Québec, Quebec, Canada

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Brno, , Czechia

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Hradec Králové, , Czechia

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Olomouc, , Czechia

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Ostrava-Poruba, , Czechia

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Prague, , Czechia

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Prague, , Czechia

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Aalborg, , Denmark

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Copenhagen, , Denmark

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Odense C, , Denmark

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Vejle, , Denmark

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Helsinki, , Finland

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Tampere, , Finland

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Turku, , Finland

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Bayonne, , France

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Brest, , France

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Dijon, , France

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Nantes, , France

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Nîmes, , France

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Paris, , France

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Pierre-Bénite, , France

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Rennes, , France

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Tours, , France

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Cologne, , Germany

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Leipzig, , Germany

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München, , Germany

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Rostock, , Germany

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Tübingen, , Germany

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Athens, , Greece

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Athens, , Greece

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Pátrai, , Greece

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Budapest, , Hungary

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Debrecen, , Hungary

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Gyula, , Hungary

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Kaposvár, , Hungary

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Ancona, , Italy

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Bologna, , Italy

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Brescia, , Italy

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Cagliari, , Italy

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Catania, , Italy

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Florence, , Italy

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Genova, , Italy

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Napoli, , Italy

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Pavia, , Italy

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Piacenza, , Italy

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Pisa, , Italy

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Roma, , Italy

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Roma, , Italy

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Torino, , Italy

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Toyohashi, Aichi-ken, Japan

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Fukuoka, Fukuoka, Japan

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Ogaki-shi, Gifu, Japan

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Maebashi, Gunma, Japan

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Shibukawa-shi, Gunma, Japan

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Sapporo, Hokkaido, Japan

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Isehara-shi, Kanagawa, Japan

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Kyoto, Kyoto, Japan

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Sendai, Miyagi, Japan

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Okayama, Okayama-ken, Japan

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Suita-shi, Osaka, Japan

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Kawagoe-shi, Saitama, Japan

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Utsunomiya, Tochigi, Japan

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Chuo-ku, Tokyo, Japan

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Koto-ku, Tokyo, Japan

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Shibuya-ku, Tokyo, Japan

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Tachikawa-shi, Tokyo, Japan

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Fukuoka, , Japan

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Nagoya, , Japan

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Niigata, , Japan

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Tokushima, , Japan

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Christchurch, , New Zealand

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Otahuhu, Auckland, , New Zealand

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Oslo, , Norway

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Trondheim, , Norway

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Brzozów, , Poland

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Chorzów, , Poland

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Katowice, , Poland

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Krakow, , Poland

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Lodz, , Poland

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Olsztyn, , Poland

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Poznan, , Poland

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Torun, , Poland

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Warsaw, , Poland

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Wroclaw, , Poland

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Brasov, , Romania

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Bucharest, , Romania

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Seville, Andalusia, Spain

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Zaragoza, Aragon, Spain

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Palma de Mallorca, Balearic Islands, Spain

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Salamanca, Castille and León, Spain

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Badalona, Catalonia, Spain

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Barcelona, Catalonia, Spain

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Girona, Catalonia, Spain

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Pamplona, Navarre, Spain

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Madrid, , Spain

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Madrid, , Spain

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Madrid, , Spain

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Gothenburg, , Sweden

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Helsingborg, , Sweden

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Lund, , Sweden

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Stockholm, , Sweden

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Stockholm, , Sweden

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Uddevalla, , Sweden

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Bournemouth, , United Kingdom

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London, , United Kingdom

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London, , United Kingdom

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Manchester, , United Kingdom

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Nottingham, , United Kingdom

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Sheffield, , United Kingdom

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Wolverhampton, , United Kingdom

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Countries

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United States Australia Belgium Canada Czechia Denmark Finland France Germany Greece Hungary Italy Japan New Zealand Norway Poland Romania Spain Sweden United Kingdom

References

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Moreau P, Mateos MV, Berenson JR, Weisel K, Lazzaro A, Song K, Dimopoulos MA, Huang M, Zahlten-Kumeli A, Stewart AK. 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. Lancet Oncol. 2018 Jul;19(7):953-964. doi: 10.1016/S1470-2045(18)30354-1. Epub 2018 Jun 1.

Reference Type BACKGROUND
PMID: 29866475 (View on PubMed)

Facon T, Niesvizky R, Mateos MV, Siegel D, Rosenbaum C, Bringhen S, Weisel K, Ho PJ, Ludwig H, Kumar S, Wang K, Obreja M, Yang Z, Klippel Z, Mezzi K, Goldrick A, Tekle C, Dimopoulos MA. Efficacy and safety of carfilzomib-based regimens in frail patients with relapsed and/or refractory multiple myeloma. Blood Adv. 2020 Nov 10;4(21):5449-5459. doi: 10.1182/bloodadvances.2020001965.

Reference Type BACKGROUND
PMID: 33166401 (View on PubMed)

Dimopoulos MA, Niesvizky R, Weisel K, Siegel DS, Hajek R, Mateos MV, Cavo M, Huang M, Zahlten-Kumeli A, Moreau P. Once- versus twice-weekly carfilzomib in relapsed and refractory multiple myeloma by select patient characteristics: phase 3 A.R.R.O.W. study subgroup analysis. Blood Cancer J. 2020 Mar 9;10(3):35. doi: 10.1038/s41408-020-0300-y.

Reference Type BACKGROUND
PMID: 32152297 (View on PubMed)

Moreau P, Stewart KA, Dimopoulos M, Siegel D, Facon T, Berenson J, Raje N, Berdeja JG, Orlowski RZ, Yang H, Ma H, Klippel Z, Zahlten-Kumeli A, Mezzi K, Iskander K, Mateos MV. Once-weekly (70 mg/m2 ) vs twice-weekly (56 mg/m2 ) dosing of carfilzomib in patients with relapsed or refractory multiple myeloma: A post hoc analysis of the ENDEAVOR, A.R.R.O.W., and CHAMPION-1 trials. Cancer Med. 2020 May;9(9):2989-2996. doi: 10.1002/cam4.2945. Epub 2020 Feb 28.

Reference Type BACKGROUND
PMID: 32108443 (View on PubMed)

Moreau P, Kumar S, Boccia R, Iida S, Goldschmidt H, Cocks K, Trigg A, Zahlten-Kumeli A, Yucel E, Panjabi SS, Dimopoulos M. Convenience, satisfaction, health-related quality of life of once-weekly 70 mg/m2 vs. twice-weekly 27 mg/m2 carfilzomib (randomized A.R.R.O.W. study). Leukemia. 2019 Dec;33(12):2934-2946. doi: 10.1038/s41375-019-0480-2. Epub 2019 May 15.

Reference Type BACKGROUND
PMID: 31092895 (View on PubMed)

Kumar SK, Majer I, Panjabi S, Medhekar R, Campioni M, Dimopoulos MA. Cost-effectiveness of once weekly carfilzomib 70 mg/m2 plus dexamethasone in patients with relapsed and refractory multiple myeloma in the United States. Expert Rev Hematol. 2020 Jun;13(6):687-696. doi: 10.1080/17474086.2020.1746639. Epub 2020 Apr 6.

Reference Type BACKGROUND
PMID: 32249621 (View on PubMed)

Dimopoulos MA, Moreau P, Iida S, Huang SY, Takezako N, Chng WJ, Zahlten-Kumeli A, Sersch MA, Li J, Huang M, Lee JH. Outcomes for Asian patients with multiple myeloma receiving once- or twice-weekly carfilzomib-based therapy: a subgroup analysis of the randomized phase 3 ENDEAVOR and A.R.R.O.W. Trials. Int J Hematol. 2019 Oct;110(4):466-473. doi: 10.1007/s12185-019-02704-z. Epub 2019 Aug 6.

Reference Type DERIVED
PMID: 31388932 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Related Links

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http://www.amgentrials.com

AmgenTrials clinical trials website

Other Identifiers

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2014-005325-12

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

20140355

Identifier Type: OTHER

Identifier Source: secondary_id

CFZ014

Identifier Type: -

Identifier Source: org_study_id

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