Updates in Use of Proteasome Inhibitors for Relapsed/Refractory Multiple Myeloma - Episode 5
Reflections on the patient-reported adherence and outcome data with IRd (ixazomib, lenalidomide, dexamethasone) therapy after an in-class transition from bortezomib to ixazomib for patients with multiple myeloma.
Paul G. Richardson, MD: As you can tell with the continuity question, these data are quite nice. They show that the patient reported adherence to this oral regimen, which is reflected by these reports from the patients of their comfort with the oral medication. There were very few patients in the poor and fair categories not tolerating their oral meds, which is really important. This is a nice aspect of the study, which I found important and interesting. You and I are conducting big phase 3 studies together, looking at pure measurements. A simple questionnaire like this is quite interesting because it tells you a lot. The fact that excellent and very good stays solidly north of 70% or 80% throughout is encouraging.
Cristina Gasparetto, MD: Absolutely. Some drugs come with what we call cumulative toxicity. I was also impressed that there was no major difference between cycles 1 and 5. Sometimes we start aggressively, and then we have to make a lot of dose-adjustment modifications because of the cumulative toxicity. But in this situation, I was surprised that there was good adherence and that patients were self-reporting the medication adherence during the continuation of treatment.
Paul G. Richardson, MD: That’s an excellent point. This suggests that you’re not dealing with cumulative toxicities that worsen over time. That’s remarkable from this data set, and I agree that it reinforces the real-world value of this regimen. That’s even further supported than the classic patient-reported outcomes, which are more typical of validated core quality-of-life [QoL] measurements.
I’m really glad to see this, because clinicians take that for granted. We always think about grade 3, 4, 5 toxicity, but the reality is that grade 2 painful neuropathy for a patient is a big deal. It’s not a grade 3, but it’s grade 2. The ability to capture quality-of-life measurements is increasingly important. I like this part of the paper. It brings out from the investigators some very nice messaging. The results show over time that QoL improves, which is great to see. There’s no sting in the tail from this regimen, if you excuse the term. In terms of patient satisfaction, you can look at patients getting used to their first couple of cycles and then, over time, clearly recognizing the benefit. It’s also particularly nice that peripheral neuropathy plateaus with this regimen; it doesn’t continue to rise. That’s always a reassuring signal.
Cristina Gasparetto, MD: Absolutely, I agree.
Transcript edited for clarity.