ASH 2015
First all-oral treatment for relapsed and treatment-resistant multiple myeloma
Prof Philippe Moreau - University of Nantes, Nantes, France
Can you tell me, you’ve been using ixazomib, what was the setting? You’re looking at myeloma, why did you go for this drug and in what setting?
Ixazomib is an oral proteasome inhibitor and we do have some rationale to combine proteasome inhibitors with IMiDs in fact and lenalidomide and dexamethasone is one of the standards of care in the relapsed setting. So the idea was to combine len-dex plus ixazomib and to do a phase III randomised study to compare len-dex-ixa versus len-dex placebo in patients with relapsed myeloma.
What would normally be the options in relapsed or refractory multiple myeloma then, with your patients?
One of the standards of care is lenalidomide and dexamethasone, that’s what we are using in routine practice so we wanted to know if the addition of a third drug will add, in terms of efficacy, progression free survival that was a primary endpoint.
OK, so you’ve got a study with len-dex plus or minus the new drug, ixazomib, what happened?
We are showing that the addition of ixazomib, an oral drug with a flat dose of 4mg weekly on day 1, 8 and 15 in 28 day cycles is improving progression free survival by 35% from 14 to 20 months. So this is a meaningful improvement, significantly important in my opinion.
What about toxicity?
In addition, this triplet combination is a very safe one because the addition of ixazomib is not increasing the toxicity of lenalidomide and dexamethasone. So a very safe triplet combination, very effective, convenient because all oral. So we have here something that is very important for the patients.
What do you think are the clinical implications coming out of this then?
I think that it will be a change of practice because usually the patients are going to the hospital to receive IV drugs etc and they will be able to receive an oral triplet combination and stay at home. So that’s a very important point for the patients.
The take-home message for cancer doctors then?
The take-home message is as soon as this ixazomib will be available in Europe, it is approved very recently in the US, I guess that we should use this combination for the patients.
