Multiple myeloma experts share background for discussion of the recent publication, “Survival benefit of ixazomib, lenalidomide and dexamethasone [IRD] over lenalidomide and dexamethasone [Rd] in relapsed and refractory multiple myeloma patients in routine clinical practice.”
Suzanne Fanning, DO: Welcome to this CancerNetworks® Between the Lines journal club this afternoon. I am Dr Suzanne Fanning. I am a medical oncologist and transplant physician at the Prisma Health Cancer Institute in Greenville, South Carolina. Today’s article is, “Survival benefit of ixazomib, lenalidomide and dexamethasone [IRD] over lenalidomide and dexamethasone [Rd] in relapsed and refractory multiple myeloma patients in routine clinical practice.”
Joshua Richter, MD: Hi, I’m Dr Joshua Richter, associate professor of medicine at the Tisch Cancer Institute Icon School of Medicine at Mount Sinai, New York, and the director of myeloma of the Blavatnik Family Chelsea Medical Center at Mount Sinai.
Suzanne Fanning, DO: On this slide, we are looking at the TOURMALINE-MM1 trial, which was the randomized double-blind placebo-controlled phase 3 trial that compared ixazomib, lenalidomide, and dexamethasone to lenalidomide and dexamethasone in patients with relapsed and refractory multiple myeloma. Here, we can see that patients with relapsed disease, they had measurable disease, 1 to 3 prior treatments, creatinine clearance greater than 30 mL/min; no patients refractory to PIs [proteasome inhibitors] or IMiDs [immunomodulatory imide drugs] were allowed. There were 722 patients enrolled in the trial, and they were randomized either to ixazomib 4 mg weekly, lenalidomide 25 mg administered days 1 through 21 of a 28-day cycle, and dexamethasone 40 mg weekly compared to placebo with lenalidomide and dexamethasone at the same dosing. These patients remained on trial on 28-day cycles until progressive disease or unacceptable toxicity.
Joshua Richter, MD: I think one of the things that’s important for the people listening is obviously, this is a starting dose for patients with good renal function and no other comorbidities or not a lot of comorbidities compared to what we may see in the community. So it’s important to refer to the lenalidomide package insert for how to dose when your creatinine clearance goes down. Ixazomib doesn’t need any dosing unless you are on hemodialysis, in which case you would go down to 3 mg. The 40 mg of dexamethasone is usually pretty good for patients without brittle diabetes or over the age of 75. Once you get over 75, we’re usually using 20 mg.
Transcript edited for clarity.