In a nutshell
This article investigated the safety and effectiveness of ixazomib (Ninlaro), melphalan (Alkeran), and prednisone (Deltasone) followed by maintenance (treatment meant to keep cancer from coming back) ixazomib for patients with multiple myeloma. The authors concluded that this therapy is safe and can improve the overall survival of these patients.
Some background
Bortezomib-based therapy is the standard treatment for patients with multiple myeloma not eligible for transplant. However, it is associated with peripheral neuropathy (damage to the nerves of the hands and feet causing weakness, numbness, and pain). It also requires once to twice weekly clinic visits for administration.
An alternative treatment is with a proteasome inhibitor ixazomib. It blocks enzymes that break down proteins. It can be given in combination with melphalan (a chemotherapy drug which destroys cancer cells) and prednisone (an anti-inflammatory drug). The effects on overall survival and safety of ixazomib–melphalan–prednisone and maintenance treatment with ixazomib are still under investigation.
Methods & findings
This study involved 61 patients with untreated multiple myeloma. All patients were given different doses of once weekly or twice weekly ixazomib with melphalan and prednisone. Of the 61 patients, 26 patients were given the recommended ixazomib dose (4mg on days 1, 8 and 15) plus melphalan and prednisone. After 13 cycles of 28 days or 9 cycles of 42 days, 36 patients received ixazomib maintenance treatment.
After an average of 43.6 months, 66% of patients responded to treatment. 48% of patients had little or no cancer cells in the blood after treatment. The average progression-free survival (PFS; the time it took for cancer to start growing again) was 22.1 months. For patients who had the maintenance treatment, PFS was 27.5 months and 38.7 months in the group who had the recommended after maintenance ixazomib. The average overall survival was 54.4 months.
Side effects experienced by patients included low platelet cell count (cells involved in blood clotting), low white blood cell count needed to fight infection, anemia and diarrhea.
The bottom line
The study concluded that the combination of ixazomib, melphalan, and prednisone and maintenance treatment with ixazomib is safe and effective for patients with multiple myeloma that are not suitable for transplant.
The fine print
This study was funded by Millennium Pharmaceuticals, the manufacturer of ixazomib. This was only a phase I/II trial. Further studies are needed to evaluate this treatment.
Published By :
Haematologica
Date :
Aug 31, 2018
