Ixazomib, lenalidomide and dexamethasone consolidation with randomized ixazomib or lenalidomide maintenance after autologous transplant in newly diagnosed multiple myeloma

• Type of Material: Article
• Authors: Michael Slade, Washington University in St. Louis; Thomas G. Martin, University of California San Francisco; Nitya Nathwani, City of Hope Comprehensive Cancer Center; Mark A. Fiala, Washington University in St. Louis; Michael P. Rettig, Washington University in St. Louis; Feng Gao, Washington University in St. Louis; Abhinav Deol, Wayne State University; Francis K. Buadi, Mayo Clinic; Jonathan Kaufman, Emory University; Craig Hofmeister, Emory University; Tara K. Gregory, Sarah Cannon Research Institute; Jesus Berdeja, Sarah Cannon Research Institute; Ajai Chari, Icahn School of Medicine at Mount Sinai; Ashley Rosko, Ohio State University; Ravi Vij, Washington University in St. Louis
• Language: English
• Date: 2022-09-16
• Publisher: SPRINGERNATURE
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022, The Author(s), under exclusive licence to Springer Nature Limited
• Final Published Version (URL): http://dx.doi.org/10.1038/s41375-022-01691-1
• Title of Journal or Parent Work: LEUKEMIA
• Volume: 36
• Issue: 12
• Start Page: 2917
• End Page: 2921
• Grant/Funding Information: The Siteman Cancer Center is supported in part by an NCI Cancer Center Support Grant #P30 CA91842. MS was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number TL1TR002344. MPR was supported by an NCI Research Specialist Award (R50CA211466). This study was also supported (in part) by research funding from Takeda, who provided ixazomib and material support for the trial, and Adaptive Biotechnologies, who performed clonoSEQ analysis at no charge.
• Keywords: Hematology; Oncology; BORTEZOMIB; Science & Technology; Life Sciences & Biomedicine; STEM-CELL TRANSPLANTATION; ORAL IXAZOMIB
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Oncology

Abstract

In eligible patients with newly diagnosed multiple myeloma (NDMM), frontline autologous stem cell transplant (ASCT) is standard of care.1 However, the use of consolidation after ASCT remains controversial, with landmark trials yielding conflicting results.2–4 There is interest in consolidation regimens that are efficacious yet less toxic and more convenient. A potential candidate is the all-oral triplet of ixazomib, lenalidomide and dexamethasone (IRd), which reduces required healthcare visits relative to other proteasome inhibitor (PI)-based regimens.5 A second unresolved aspect of post-ASCT therapy is the optimal maintenance strategy. Lenalidomide maintenance is standard of care, but is associated with significant toxicities, leading to a discontinuation rate of approximately 50% at 2 years.6 Two years of post-ASCT maintenance ixazomib was demonstrated to improve PFS relative to placebo, with a toxicity profile comparable to the control arm.7 However, randomized data comparing lenalidomide and ixazomib is lacking.