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Ixazomib, lenalidomide, and dexamethasone combination in “real-world” clinical practice in patients with relapsed/refractory multiple myeloma

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Abstract

Ixazomib is approved for use in combination with lenalidomide and dexamethasone (IRd) for patients with multiple myeloma (MM) who received at least one previous therapy. Registration study “TOURMALINE MM-1” was published in 2016. Nevertheless, clinical trials are significantly different from real-world use. From June 2016 to December 2018, IRd was available for Slovak patients with relapsed/refractory MM through a Named Patient Program. The aim of this study was to evaluate the efficacy and safety of ixazomib. We analyzed in this cohort study outcomes of 106 MM patients treated with IRd at 2 academic centers. The median age at diagnosis was 63 years (44–78). The median number of prior lines was 2 (1–7). The majority had high international staging system (ISS) score: 18, 29, and 59 were in the ISS I, ISS II, and ISS III groups, respectively. Treatment continued until progression, unacceptable toxicity, or death. The median follow-up for the entire cohort was 29 (0–49) months. The overall response rate was 74.5% (complete remission, 7.5%; partial remission, 67%). The median overall survival was not reached. Median progression-free survival (PFS) was 43 months (95% CI 35.6–50.4). The Kaplan–Meier method was used to generate survival curves, and we compared the influence of different factors on PFS. The most common hematological adverse events of any grade were neutropenia (90.4%), anemia (55.6%), and thrombocytopenia (43.4%). Our real-world data support the use of IRd as a highly effective and well-tolerated oral treatment protocol for relapsed myeloma.

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Research data are stored in an institutional repository and will be shared upon request to the corresponding author.

References

  1. Parrondo RD, Alegria V, Roy V, Sher T, Chanan-Khan AA, Ailawadhi S (2021) Ixazomib and lenalidomide maintenance therapy in multiple myeloma. Ann Hematol 100(3):851–853. https://doi.org/10.1007/s00277-020-04340-8

    Article  PubMed  Google Scholar 

  2. Li J, Bao L, Xia Z, Wang S, Zhou X, Ding K, Zhang W, Yang W, Li B, Fu C, Chen B, Hua L, Wang L, Luo J, Yang Y, Xu T, Wang W, Huang Y, Wu G, Liu P (2020) Ixazomib-based frontline therapy in patients with newly diagnosed multiple myeloma in real-life practice showed comparable efficacy and safety profile with those reported in clinical trial: a multi-center study. Ann Hematol 99(11):2589–2598. https://doi.org/10.1007/s00277-020-04234-9

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. Röllig C, Knop S, Bornhäuser M (2015) Multiple myeloma. Lancet 385(9983):2197–208. https://doi.org/10.1016/S0140-6736(14)60493-1

    Article  PubMed  CAS  Google Scholar 

  4. Leleu X, Martin TG, Einsele H, Lyons RM, Durie BGM, Iskander KS, Ailawadhi S (2019) Role of proteasome inhibitors in relapsed and/or refractory multiple myeloma. Clin Lymphoma Myeloma Leuk 19(1):9–22. https://doi.org/10.1016/j.clml.2018.08.016

    Article  PubMed  Google Scholar 

  5. Moreau P, Masszi T, Grzasko N, Bahlis NJ, Hansson M, Pour L, Sandhu I, Ganly P, Baker BW, Jackson SR, Stoppa AM, Simpson DR, Gimsing P, Palumbo A, Garderet L, Cavo M, Kumar S, Touzeau C, Buadi FK, Laubach JP, Berg DT, Lin J, Di Bacco A, Hui AM, van de Velde H, Richardson PG, TOURMALINE-MM1 Study Group (2016) Oral ixazomib, lenalidomide, and dexamethasone for multiple myeloma. N Engl J Med 374(17):1621–34. https://doi.org/10.1056/NEJMoa1516282

    Article  PubMed  CAS  Google Scholar 

  6. Mansournia MA, Higgins JP, Sterne JA, Hernán MA (2017) Biases in randomized trials: a conversation between trialists and epidemiologists. Epidemiology 28(1):54–59. https://doi.org/10.1097/EDE.0000000000000564

    Article  PubMed  PubMed Central  Google Scholar 

  7. Ramagopalan SV, Simpson A, Sammon C (2020) Can real-world data really replace randomised clinical trials? BMC Med 18(1):13. https://doi.org/10.1186/s12916-019-1481-8

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kumar S, Paiva B, Anderson KC, Durie B, Landgren O, Moreau P, Munshi N, Lonial S, Bladé J, Mateos MV, Dimopoulos M, Kastritis E, Boccadoro M, Orlowski R, Goldschmidt H, Spencer A, Hou J, Chng WJ, Usmani SZ, Zamagni E, Shimizu K, Jagannath S, Johnsen HE, Terpos E, Reiman A, Kyle RA, Sonneveld P, Richardson PG, McCarthy P, Ludwig H, Chen W, Cavo M, Harousseau JL, Lentzsch S, Hillengass J, Palumbo A, Orfao A, Rajkumar SV, Miguel JS, Avet-Loiseau H (2016) International Myeloma Working Group consensus criteria for response and minimal residual disease assessment in multiple myeloma. Lancet Oncol 17(8):e328–e346. https://doi.org/10.1016/S1470-2045(16)30206-6

    Article  PubMed  Google Scholar 

  9. Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, Kumar S, Hillengass J, Kastritis E, Richardson P, Landgren O, Paiva B, Dispenzieri A, Weiss B, LeLeu X, Zweegman S, Lonial S, Rosinol L, Zamagni E, Jagannath S, Sezer O, Kristinsson SY, Caers J, Usmani SZ, Lahuerta JJ, Johnsen HE, Beksac M, Cavo M, Goldschmidt H, Terpos E, Kyle RA, Anderson KC, Durie BG, Miguel JF (2014) International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol 15(12):e538–e548. https://doi.org/10.1016/S1470-2045(14)70442-5

    Article  PubMed  Google Scholar 

  10. Greipp PR, San Miguel J, Durie BG, Crowley JJ, Barlogie B, Bladé J, Boccadoro M, Child JA, Avet-Loiseau H, Kyle RA, Lahuerta JJ, Ludwig H, Morgan G, Powles R, Shimizu K, Shustik C, Sonneveld P, Tosi P, Turesson I, Westin J (2005) International staging system for multiple myeloma. J Clin Oncol 23(15):3412–3420. https://doi.org/10.1200/JCO.2005.04.242

    Article  PubMed  Google Scholar 

  11. Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Available at: https://ctep.cancer.gov/protocoldevelopment/electronic_applications/ctc.htm#ctc_60. Accessed June 21, 2021

  12. Smolewski P, Rydygier D (2019) Ixazomib: an investigational drug for the treatment of lymphoproliferative disorders. Expert Opin Investig Drugs 28(5):421–433. https://doi.org/10.1080/13543784.2019.1596258

    Article  PubMed  CAS  Google Scholar 

  13. Muz B, Ghazarian RN, Ou M, Luderer MJ, Kusdono HD, Azab AK (2016) Spotlight on ixazomib: potential in the treatment of multiple myeloma. Drug Des Devel Ther 10:217–226. https://doi.org/10.2147/DDDT.S93602

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  14. Kupperman E, Lee EC, Cao Y, Bannerman B, Fitzgerald M, Berger A, Yu J, Yang Y, Hales P, Bruzzese F, Liu J, Blank J, Garcia K, Tsu C, Dick L, Fleming P, Yu L, Manfredi M, Rolfe M, Bolen J (2010) Evaluation of the proteasome inhibitor MLN9708 in preclinical models of human cancer. Cancer Res 70(5):1970–1980. https://doi.org/10.1158/0008-5472.CAN-09-2766

    Article  PubMed  CAS  Google Scholar 

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Funding

The study was supported by grants VEGA 1/0187/17 and APVV-17–0054.

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All authors drafted and reviewed the manuscript, approved the final version, and decided to publish this report, and they vouch for data accuracy and completeness. JSO, TG, JC, MH, NS, LV, and MK participated in the conception and study design, acquired data, and contributed to the analysis and interpretation of results. JSO and JS contributed to the writing of the final version of the manuscript.

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Correspondence to Tomas Guman.

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Informed consent was obtained from all participants included in the study.

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Sokol, J., Guman, T., Chudej, J. et al. Ixazomib, lenalidomide, and dexamethasone combination in “real-world” clinical practice in patients with relapsed/refractory multiple myeloma. Ann Hematol 101, 81–89 (2022). https://doi.org/10.1007/s00277-021-04663-0

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  • DOI: https://doi.org/10.1007/s00277-021-04663-0

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