What is the benefit of adding ixazomib to lenalidomide and dexamethasone for relapsing/refractory multiple myeloma?

This study investigated the effects of adding ixazomib (Ninlaro) to lenalidomide (Revlimid) and dexamethasone (Dexasone) for patients with unresponsive multiple myeloma. The main finding was that patients receiving ixazomib plus lenalidomide and dexamethasone survived longer without worsening of cancer (progression-free survival) compared to patients receiving placebo (a false treatment for comparison) plus lenalidomide and dexamethasone

Many patients respond well to therapy for multiple myeloma. However some relapse (loss of response over time) and some are refractory (do not respond). Lenalidomide, dexamethasone and ixazomib are therapies commonly used to treat relapsing/refractory multiple myeloma. Lenalidomide is a drug which alters the immune system. Dexamethasone is a steroid drug that reduces inflammation. Ixazomib is a targeted therapy which attacks only cancer cells. Progression free survival (PFS) means that the cancer does not get worse over the course of treatment. PFS is commonly assessed in clinical trials for cancer drugs.  It is important to investigate the effects of different therapy combinations for relapsing/refractory multiple myeloma.

Seven hundred and twenty-two patients with relapsing/refractory multiple myeloma were included. The patients had previously received 1-3 different therapies. Patients were randomized into two groups. Three hundred and thirty patients received ixazomib, lenalidomide and dexamthasone (IRd). Three hundred and thirty-three patients received placebo plus lenalidomide and dexamethasone (Rd). PFS, quality of life, and physical, emotional, and social function were assessed. Patients administered IRd were followed for an average of 23 months. Patients administered a placebo plus Rd were followed for an average of 24 months.

PFS was an average of 20.6 months for patients on IRd. PFS was an average of 14.7 months for patients on Rd plus placebo. There were no differences in quality of life between the patients who received IRd and those that received Rd plus placebo. Physical, emotional, and social function were slightly greater in patients treated with IRd than patients treated with Rd plus placebo. Patients receiving IRd experienced more side effects. Tjhese included diarrhoea, rash, and constipation.

This study concluded that adding ixazomib enhances the effectiveness of treatment with lenalidomide and dexamethasone for multiple myeloma.

Patients were only followed for less than two years. Therefore, from this study the long-term effectiveness of these therapies are unknown.

If you have questions about the management of multiple myeloma, please consult your doctor.