Robert A. Vescio, MD:When this patient was first treated for her high-risk disease, she received triplet therapy, and it seemed to work. When she stopped the proteasome inhibitor, her disease ultimately progressed.
When we use 3 drugs, it’s often hard to know which of the 3 drugs is the most important. Sometimes we learn that out later. Again, given her high-risk disease with the t(4;14) translocation, I would generally be in favor of using a proteasome inhibitor, particularly since she was using one that worked initially. So, I would give her the option of going back to bortezomib or ixazomib or, for that matter, Kyprolis (carfilzomib). Again, I think convenience is important to patients, and I’m certainly fine with her using ixazomib as a more simple, effective regimen to start.
The TOURMALINE-MM1 trial compared the use of lenalidomide and dexamethasone to a triplet regimenixazomib, lenalidomide, and dexamethasone—as treatment for patients with relapsed multiple myeloma. An improved progression-free survival was seen in the patients who took the ixazomib-containing regimen. The patients were then analyzed based on their risk categories, and there was an advantage in progression-free survival for both the standard-risk patients and the high-risk patients. This kind of backs up the fact that patients with high-risk disease tend to do better with a regimen that includes a proteasome inhibitor, such as ixazomib, versus one without.
Transcript edited for clarity.
A 55-year-old African-American Woman With Relapsed Multiple Myeloma