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    EudraCT Number:2018-000665-36
    Sponsor's Protocol Code Number:20180015
    National Competent Authority:Netherlands - Competent Authority
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2019-01-08
    Trial results
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    A. Protocol Information
    A.1Member State ConcernedNetherlands - Competent Authority
    A.2EudraCT number2018-000665-36
    A.3Full title of the trial
    A Randomized, Open-label, Phase 3 Study Comparing Once-weekly vs Twice-weekly Carfilzomib in Combination with Lenalidomide and Dexamethasone in Subjects With Relapsed or Refractory Multiple Myeloma (A.R.R.O.W.2)
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Study Comparing Once-weekly vs Twice-weekly Carfilzomib in Combination with Lenalidomide and Dexamethasone in Subjects With Relapsed or Refractory Multiple Myeloma
    A.3.2Name or abbreviated title of the trial where available
    A.4.1Sponsor's protocol code number20180015
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorAmgen Inc
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportAmgen Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationAmgen (EUROPE) GmbH
    B.5.2Functional name of contact pointIHQ Medical Info-Clinical Trials
    B.5.3 Address:
    B.5.3.1Street AddressDammstrasse 23, P.O Box 1557
    B.5.3.2Town/ cityZug
    B.5.3.3Post codeCH-6300
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D. name Kyprolis
    D. of the Marketing Authorisation holderAmgen Europe B.V
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community Yes
    D.2.5.1Orphan drug designation numberEU/3/08/548
    D.3 Description of the IMP
    D.3.1Product nameCarfilzomib Lyophilisate for Solution for Injection
    D.3.2Product code PR-171
    D.3.4Pharmaceutical form Powder for solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNcarfilzomib
    D.3.9.1CAS number 868540-17-4
    D.3.9.2Current sponsor codePR-171
    D.3.9.3Other descriptive nameCARFILZOMIB
    D.3.9.4EV Substance CodeSUB32911
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number2
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D. cell therapy medicinal product No
    D. therapy medical product No
    D. Engineered Product No
    D. ATIMP (i.e. one involving a medical device) No
    D. on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Relapsed or Refractory Multiple Myeloma
    E.1.1.1Medical condition in easily understood language
    Bone marrow Cancer
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10028228
    E.1.2Term Multiple myeloma
    E.1.2System Organ Class 100000004864
    E.1.3Condition being studied is a rare disease Yes
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    compare efficacy of
    56 mg/m2 carfilzomib administered
    once-weekly in combination with
    lenalidomide and dexamethasone
    (KRd 56 mg/m2) to
    27 mg/m2 carfilzomib administered
    twice-weekly in combination with
    lenalidomide and dexamethasone
    (KRd 27 mg/m2) in subjects with
    RRMM with 1 to 3 prior lines of
    E.2.2Secondary objectives of the trial
    *compare progression-free survival
    (PFS) between treatment arms
    *compare patient-reported
    convenience with carfilzomib-dosing
    schedule between treatment arms
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    *Subject has provided informed consent prior to initiation of any study-specific
    activities or procedures or subject’s legally acceptable representative has
    provided informed consent prior to any study-specific activities/procedures being
    initiated when the subject has any kind of condition that, in the opinion of the
    Investigator, may compromise the ability of the subject to give written informed
    *Males or females ≥ 18 years of age.
    *Documented relapse or progressive multiple myeloma on or after any treatment
    (subjects refractory to the most recent line of therapy are eligible, unless last
    treatment contained PI or lenalidomide and dexamethasone).
    *Subjects must have at least PR to at least 1 line of prior therapy.
    *Subjects must have received at least 1 but not more than 3 prior lines of therapy
    for multiple myeloma (induction therapy followed by stem cell transplant and
    consolidation maintenance therapy will be considered as 1 line of therapy). See
    Section 12.8 for guidelines for documenting prior treatment.
    *Prior therapy with a PI or lenalidomide and dexamethasone is allowed, as long
    as the patient had at least a PR to most recent therapy with PI or lenalidomide
    and dexamethasone, was not removed due to toxicity, and will have at least a
    6-month PI or lenalidomide and dexamethasone treatment-free interval from last
    dose received until first study treatment. (Patients may receive maintenance
    therapy with lenalidomide during this 6-month PI or lenalidomide and
    dexamethasone treatment-free interval).
    *Previous treatment with a lenalidomide and dexamethasone containing regimen
    is allowed, as long as the subject did not progress during the first 3 months after
    initiating lenalidomide and dexamethasone containing therapy.
    Measurable disease with at least 1 of the following assessed within 21 days prior
    to randomization:
     IgG multiple myeloma: serum monoclonal protein (M-protein) level ≥ 1.0 g/dL
     IgA, IgD, IgE multiple myeloma: serum M-protein level ≥ 0.5 g/dL
     urine M-protein ≥ 200 mg per 24 hours
     in subjects without measurable serum or urine M-protein, serum-free light
    chain (SFLC) ≥ 100 mg/L (involved light chain) and an abnormal serum
    kappa lambda ratio
    *Eastern Cooperative Oncology Group Performance Status (ECOG PS) of 0  2
    (see Section 12.9).
    E.4Principal exclusion criteria
    *Waldenström macroglobulinemia.
    *Multiple myeloma of IgM subtype.
    *POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal
    protein, and skin changes).
    *Plasma cell leukemia (> 2.0 × 109/L circulating plasma cells by standard
    *Primary amyloidosis (patients with multiple myeloma with asymptomatic
    deposition of amyloid plaques found on biopsy would be eligible if all other
    criteria are met).
    *Myelodysplastic syndrome.
    Other Medical Conditions
    *History of other malignancy within the past 5 years, with the following exceptions:
     Malignancy treated with curative intent and with no known active disease
    present for ≥ 3 years before enrollment and felt to be at low risk for
    recurrence by the treating physician
     Adequately treated non-melanoma skin cancer or lentigo maligna without
    evidence of disease
     Adequately treated cervical carcinoma in situ without evidence of disease
     Adequately treated breast ductal carcinoma in situ without evidence of
     Prostatic intraepithelial neoplasia without evidence of prostate cancer
     Adequately treated urothelial papillary noninvasive carcinoma or carcinoma in
     Treated medullary or papillary thyroid cancer
     Similar neoplastic conditions with an expectation of > 95% 5-year
    disease-free survival
    *Known HIV infection, hepatitis C infection (subjects with hepatitis C that achieve
    a sustained virologic response after antiviral therapy are allowed), or hepatitis B
    infection (subjects with hepatitis B surface antigen or core antibody that achieve
    sustained virologic response with antiviral therapy are allowed). Tests to be
    performed if required per local country regulations.
    *Ongoing graft-vs-host disease.
    *Acute active infection requiring systemic antibiotics, antifungal, antiviral (except
    antiviral therapy directed at hepatitis B) agents within 14 days prior to
    *Known cirrhosis.
    *Significant neuropathy (grades 3 to 4, or grade 2 with pain) within 14 days prior
    to randomization.
    *Subjects with pleural effusions requiring thoracentesis or ascites requiring
    paracentesis within 14 days prior to randomization.
    Cardiopulmonary Conditions
    *Uncontrolled hypertension, defined as an average systolic blood pressure
    ≥ 160 mmHg or diastolic ≥ 100 mmHg despite optimal treatment (measured
    following European Society of Hypertension/European Society of Cardiology
    2013 guidelines; Section 12.10).
    *Active congestive heart failure (New York Heart Association Class III to IV),
    symptomatic ischemia, uncontrolled arrhythmias, screening ECG with corrected
    QT interval (QTc) of > 470 msec, pericardial disease, or myocardial infarction
    within 4 months prior to randomization.
    *Intolerance to hydration due to pre-existing pulmonary or cardiac impairment.
    *History of interstitial lung disease or ongoing interstitial lung disease.
    Prior/Concomitant Therapy
    *Immunotherapy within 21 days prior to randomization.
    *Monoclonal antibody therapy within 21 days prior to randomization.
    *Chemotherapy with approved anticancer therapeutic within 21 days prior to
    *Glucocorticoid therapy within 14 days prior to randomization that exceeds a
    cumulative dose of 160 mg of dexamethasone or equivalent dose of other
    *Focal radiation therapy within 7 days prior to randomization. Radiation therapy to
    an extended field involving a significant volume of bone marrow within 21 days
    prior to randomization (ie, prior radiation must have been to < 30% of the bone
    *Major surgery (except kyphoplasty) within 28 days prior to randomization.
    *Autologous or allogeneic stem cell transplant within 90 days prior to
    *Contraindication or intolerance to lenalidomide, dexamethasone, or carfilzomib.
    *Known history of allergy to Captisol (a cyclodextrin derivative used to solubilize
    *Subject has known hypersensitivity to any of the products or components to be
    administered during dosing, including hypersensitivity to antiviral drugs.
    Prior/Concurrent Clinical Study Experience
    *Currently receiving treatment in another investigational device or drug study, or
    < 28 days since ending treatment on another investigational device or drug
    Organ Function Assessments
    *Hepatic dysfunction within 21 days prior to randomization:
     bilirubin  1.5x the upper limit of normal (ULN)
     aspartate aminotransferase (AST) or alanine aminotransferase (ALT)  2.5x
    *Left ventricular ejection fraction < 40% assessed by transthoracic
    echocardiogram (ECHO).
    *Absolute neutrophil count (ANC) < 1 x 109/L within 21 days prior to
    randomization. Screening ANC should be independent of growth factor support
    for ≥ 1 week.
    E.5 End points
    E.5.1Primary end point(s)
    overall response rate (ORR, defined
    as the proportion of best overall
    response of stringent complete
    response [sCR], complete response
    [CR], very good partial response
    [VGPR], and partial response [PR] per
    International Myeloma Working Group
    Uniform Response Criteria [IMWG-URC]) over the duration of the study
    E.5.1.1Timepoint(s) of evaluation of this end point
    Over the duration of the study
    E.5.2Secondary end point(s)
    *1-year PFS
    *convenience as measured by the
    Patient-reported Convenience With
    Carfilzomib-dosing Schedule Question
    after cycle 4 of treatment
    E.5.2.1Timepoint(s) of evaluation of this end point
    *1-year PFS
    *convenience as measured by the
    Patient-reported Convenience With
    Carfilzomib-dosing Schedule Question
    after cycle 4 of treatment
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response Yes
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E. trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) Yes
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial2
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned4
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA47
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Czech Republic
    Korea, Republic of
    Russian Federation
    United States
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years1
    E.8.9.1In the Member State concerned months5
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial years2
    E.8.9.2In all countries concerned by the trial months4
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 230
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 230
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state22
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 254
    F.4.2.2In the whole clinical trial 460
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2019-01-08
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2019-05-09
    P. End of Trial
    P.End of Trial StatusOngoing
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