Dr. Mateos on Frail Patients With Multiple Myeloma in the ARROW Trial

Maria-Victoria Mateos, MD, PhD, associate professor of medicine, and director of the Myeloma unit at the University Hospital of Salamanca in Spain, discusses the impact of performance status on the outcomes of patients with multiple myeloma in the phase III ARROW trial.

In the ARROW trial, investigators showed that carfilzomib (Kyprolis) dosed once weekly at 70 mg/m² with dexamethasone induced a prolonged progression-free survival (PFS) versus the standard twice-weekly dose of 27 mg/m² in patients with relapsed/refractory multiple myeloma. These findings served as the basis for the FDA approval of the once-weekly regimen in October 2018.

When investigators applied a frailty score to the overall patient population, they identified 3 distinct patient populations: fit, intermediate, and frail. Each group represented approximately one-third of the total patient population and were well balanced between dosing schedules, says Mateos. The PFS benefit with the higher dose of carfilzomib was maintained irrespective of frailty status, demonstrating the feasibility of the higher dose across all patient subgroups. However, Mateos notes that fit patients derived the most benefit from the higher dose of carfilzomib with a hazard ratio of 0.53.