Ixazomib in the treatment of patients with multiple myeloma

Ixazomib, the first oral proteasome inhibitor, is approved in combination with lenalidomidedexamethasone (Ixa-Rd) for the treatment of MM patients who previously received ≥ 1 therapy. Approval was based on the results of an international multicenter, randomized, double-blind, placebo-controlled phase III study TOURMALINE-MM1. TOURMALINE-MM1 demonstrated a statistically significant improvement in progression-free survival (PFS) when using ixazomib-Rd compared with placebo-Rd in patients with recurrent/ refractory multiple myeloma (RRMM) (median PFS 20.6 vs 14.7 months) with limited additional toxicity. In the article we report on the final overall survival analysis from TOURMALINE-MM1. However, the results of clinical trials are not always translated into real results. The Ixa-Rd regimen has proven to be a safe and effective treatment option for real patients with RRMM. In any case, complete oral combination therapy in patients with PPMM has begun a new era in the treatment of this disease. Ixazomib-Rd, a fully oral triplet regimen, is an effective and well-tolerated treatment option for patients with RRMM. Ixazomib is successfully combined with other drugs (cyclophosphamide, daratumumab, pomalidomide). The phase I/II study studied the safety and efficacy of ixazomib/pomalidomide/ dexamethasone in patients who had multiple prior therapies, were refractory to lenalidomide alone, or were refractory to lenalidomide and bortezomib, or lenalidomide, bortezomib, and carfilzomib. Considering promising preliminary response rates, especially in patients refractory to both lenalidomide and a PI, the NCCN Panel has included ixazomib/pomalidomide/ dexamethasone as a treatment option for patients with relapsed/refractory MM who have received at least two prior therapy including immunomodulatory agents and a proteasome inhibitor and have demonstrated disease progression on or within 60 days of completion of the last therapy. Ixazomib-based regimens are effective and well-tolerated treatment options for patients with multiple myeloma.