Benefit of ixazomib in patients with relapsed/refractory multiple myeloma in routine clinical practice
The results of treating relapsed or refractory multiple myeloma in real-world routine clinical practice were published by a broad team of Czech experts in the journal BMC Cancer.
Observed Population
A cohort of Czech patients with relapsed/refractory multiple myeloma (RRMM), who were treated and followed within the Czech Registry of Monoclonal Gammopathies (RMG) between 2016 and 2018, included 344 individuals. They received standard therapy with lenalidomide and dexamethasone, potentially combined with ixazomib.
A head-to-head analysis then evaluated treatment outcomes of patients with RRMM treated with the IRD regimen (ixazomib, lenalidomide, and dexamethasone) versus the RD regimen (lenalidomide and dexamethasone). The IRD group included 127 patients, while the RD group included 217. The primary endpoint was progression-free survival (PFS), with secondary endpoints including treatment response and overall survival (OS).
Results
For the entire cohort, the median PFS in the IRD group was 17.5 months compared to 11.5 months in the RD group (p = 0.005). In patients with 1-3 relapses, the median PFS was 23.1 months (IRD) versus 11.6 months (RD) (p = 0.001). The hazard ratio (HR) for PFS was 0.67 (95% confidence interval [CI] 0.51-0.89; p = 0.006). Improvement in PFS also reflected in improved OS: the median OS was 36.6 months in the IRD group compared to 26.0 months in the RD group (p = 0.008).
The overall response rate (ORR) was 73% in the IRD group compared to 66.2% in the RD group, with a complete response rate of 11.1% vs. 8.8%. Very good partial response was achieved in 22.2% vs. 13.9% of patients.
The IRD regimen was most beneficial for patients under 75 years of age in stage I or II of the international prognostic index for multiple myeloma (ISS) and with 1st or 2nd relapse. Patients with extramedullary disease did not benefit from the IRD regimen.
Both treatment regimens were well-tolerated, with comparable incidence of overall toxicity and grade 3 or 4 toxicity.
Conclusion
This analysis of treatment outcomes in real clinical practice confirms previous findings from the TOURMALINE-MM1 clinical study. It also demonstrates the benefit of oral triplet therapy IRD over the doublet therapy RD. Adding ixazomib to lenalidomide and dexamethasone improves key survival parameters in patients with relapsed or refractory multiple myeloma.
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Source: Minařík J., Pika T., Radocha J. et al. Survival benefit of ixazomib, lenalidomide and dexamethasone (IRD) over lenalidomide and dexamethasone (Rd) in relapsed and refractory multiple myeloma patients in routine clinical practice. BMC Cancer 2021 Jan 15; 21 (1): 73, doi: 10.1186/s12885-020-07732-1.
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