Routine Clinical Practice Comparison of IRD and Rd in RR Multiple Myeloma - Episode 4

Subgroup Analysis of IRD vs Rd in Relapsed/Refractory Multiple Myeloma

,

Experts provide commentary on the subgroup analyses from real-world data on use of ixazomib, lenalidomide, and dexamethasone compared with lenalidomide and dexamethasone in patients with relapsed/refractory multiple myeloma.

Suzanne Fanning, DO: We have a subgroup analysis where we are breaking down the different patient populations based on age, ISS [International Staging System] stage, number of previous treatments, their response to prior therapy, whether they have extramedullary disease on the left-hand slide. Even though there were some areas that crossed the level of 1, all of the patient cohorts, with the exception of those with greater than 4 prior lines of therapy, or those with stringent CR [complete response], plus CR, and finally extramedullary disease, all benefit the triplet in comparison to the doublet. When we continue to the right-hand side of the slide, and we look at transplant in previous lines, prior PI [proteasome inhibitor], prior IMiD [immunomodulatory imide drug], as well as disease status, we can see that again, we have confidence intervals across the midline, but as a whole, in terms of subgroup analysis, we see the benefit of the triplet in comparison to the doublet.

Joshua Richter, MD: Absolutely. I love forest plots like this. They’re mind-numbing because there are so much data at once, but I also like the fact that we can drill down to which patients may benefit the most. It seems that patients who had prior transplant and did have prior PI, for example, are groups that are clearly statistically significant that don’t cross 1. That type of patient to me is VRd [bortezomib, lenalidomide, dexamethasone] followed by transplant, which is right now I think in the United States one of, if not the most common, pathways for transplant eligible. I think this makes the IRD [ixazomib, lenalidomide, dexamethasone] regimen not only practical but applicable to some of the US-based approaches to treating myeloma.

Transcript edited for clarity.