Routine Clinical Practice Comparison of IRD and Rd in RR Multiple Myeloma - Episode 5

IRD vs Rd in Relapsed/Refractory Multiple Myeloma

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Data review of IRD vs Rd in patients with relapsed/refractory multiple myeloma who had a prior autologous stem cell transplant or extramedullary disease.

Joshua Richter, MD: Now, here the granularity of both the IRD [ixazomib (Ninlaro), lenalidomide (Revlimid), and dexamethasone] and Rd [lenalidomide, dexamethasone] regimens with and without transplant from a standpoint of PFS [progression-free survival] and OS [overall survival]. In both the PFS and OS, both groups that had stem cell transplant are going to do better. The difficulty here is that this is not apples to apples because clearly the patients who are going to be eligible for stem cell transplant are typically going to be younger, fitter, better ECOG [Eastern Cooperative Oncology Group] performance status but overall, I think we do see improvements here with the IRD arm. However, to me, I think the impact of transplant kind of washes away some of it. I don’t know what you think.

Suzanne Fanning, DO: Well, I think in contrast to TOURMALINE [clinical trial], which showed that patients who’d had a previous transplant did not go on to do as well with IRD, this real-world trial did not show that. It showed that regardless of whether you’d had a prior transplant or not, all comers did better with IRD triplet compared to the doublet. As we look at PFS and OS in patients with or without extramedullary disease, as Dr Richter previously said, we know that this is a poor prognostic indicator for patients and these curves show exactly that. Unfortunately, those patients who do have extramedullary disease fare less well across the board.

Joshua Richter, MD: Not much to add. When we talk about all these great new options, it still remains one of the unmet needs of myeloma is how to manage patients with that disease that can just do whatever it wants and grow wherever it pleases.

Transcript edited for clarity.