Outcomes of ixazomib/lenalidomide/dexamethasone for multiple myeloma: A multicenter retrospective analysis

Abstract

Objectives This study aimed to investigate real‐world data of ixazomib plus lenalidomide and dexamethasone (IRd) therapy for patients with relapsed and refractory multiple myeloma (RRMM). Methods We retrospectively analyzed 122 patients treated with IRd at 16 centers from May 2017 to January 2019 by using the Kansai Myeloma Forum database. Result At the start of IRd, the median age was 72 years, 66.7% of patients had IgG type, and the median number of prior therapies was 4, comprising bortezomib (85.4%) and lenalidomide (89.3%)‐based regimens. Disease progression and adverse events accounted for treatment discontinuation in 46 and 32 patients, respectively. The median overall survival (OS) was not reached, and the median progression‐free survival (PFS) was 11.9 months. Sensitivity to bortezomib did not affect the PFS, whereas lenalidomide‐refractory patients had significantly lower PFS than lenalidomide‐sensitive patients, who were comparable to TOURMALINE‐MM1 study. The patients with IgG type had significantly better PFS and OS than those with non‐IgG type. Conclusion This study presents the largest real‐world data of patients treated with IRd in Asia. However, in real clinical practice, the patient background is different from the TOURMALINE‐MM1 study, and IRd showed poor efficacy, especially in the non‐IgG type and lenalidomide‐refractory patients with RRMM.

Efficacy of ixazomib-lenalidomide-dexamethasone in high-molecular-risk relapsed/refractory multiple myeloma – case series and literature review

“…Median PFS was 11.9 months while median OS was not reached. IRd regimen showed poor efficacy, especially in patients without the IgG M-protein component and refractory to lenalidomide [41].…”

Ixazomib, Lenalidomide and Dexamethasone in Relapsed and Refractory Multiple Myeloma in Routine Clinical Practice: Extended Follow-Up Analysis and the Results of Subsequent Therapy

“…Shorter mPFS were reported in Hungarian study, possibly due to more heavily pretreated patients and LEN supply issues, similarly the Canadian MCRN analysis and Chinese real-world analysis reported shorter mPFS, possibly due to lenalidomide or bortezomib pretreatment and due to inclusion of other ixazomib based therapies [ 24 , 25 , 26 ]. Similarly, in the retrospective analysis by Takakuwa et al, the outcomes of IRD were not favorable, probably due to previous pretreatment (with median of four prior therapies) including lenalidomide and bortezomib [ 27 ]. On the other hand, the Slovak data from routine practice demonstrated very long PFS of 43 months [ 28 ].…”

An Evaluation of the Clinical Efficacy and Safety of Ixazomib for Relapsed/Refractory Multiple Myeloma

“…In another study [17] , 90 RRMM patients who received eight cycles of IRD were observed; the results showed that the total effective rate was 51.1%; 23.3% reached CR or VGPR, 10% reached MR, and the clinical benefit rate was 61.1%; the effective rate, PFS, and overall survival (OS) were similar in patients with or without t(4;14) and/or del(17p); however, the PFS and OS were significantly shortened in patients with 1q21 gain; multiple regression analysis showed that the gain of 1q21 is the most critical factor related to OS [17] . A multicenter retrospective analysis showed that the PFS and OS of IgG patients were significantly better than those of non-IgG patients [18] . In this study, among the 20 patients, one patient achieved CR, four patients achieved VGPR, and seven patients achieved PR; the ORR was 60.00%, and 25.00% achieved VGPR or more; 14 patients continued to receive ixazomib treatment, five patients received other treatment regimen due to disease progression, and one patient died due to multiple organ failure.…”