Combination Therapy for Older Transplant-Ineligible Patients With Multiple Myeloma
Posted: Monday, September 24, 2018
An all-oral combination therapy regimen—ixazomib, melphalan, and prednisone (IMP)—appears to be safe and active among elderly patients with newly diagnosed multiple myeloma who are ineligible for stem cell transplants, according to an early-phase study published in Haematologica. Ixazomib was used in place of bortezomib, which is often difficult for this patient population to tolerate over time.
“Oral dosing, coupled with a favorable safety profile at the [recommended phase II dose], make ixazomib particularly suitable for long-term continuous therapy and may offer a more convenient, active, and well-tolerated alternative to a parenterally administered [proteasome inhibitor] in this setting,” concluded Jesús F. San-Miguel, MD, PhD, of Clinica Universidad de Navarra, Pamplona, Spain, and colleagues.
In the phase I part of the trial, the authors determined the recommended phase II dose of ixazomib, melphalan, and prednisone. In the phase II part of the trial, 61 patients were enrolled. Of them, 26 received the recommended phase II dose of triplet therapy and 36 received single-agent ixazomib maintenance.
Overall, 48% of patients experienced a complete or very good partial response at the recommended phase II dose, including 28% with a complete response or better. The authors observed a median progression-free survival of 22.1 months and an overall survival of 54.4 months. Adverse events were primarily hematologic or gastrointestinal events or peripheral neuropathy.