A recent study compared the efficacy and safety of two drug regimens for treating elderly patients with transplant-ineligible newly diagnosed multiple myeloma (TI-NDMM). The study, which took place across three hospitals in China from March 2020 to December 2022, aimed to shed light on the potential benefits of using Ixazomib versus Lenalidomide combined with cyclophosphamide and dexamethasone.
Ixazomib (ICd) and Lenalidomide (RCd) have emerged as integral components of multi-drug regimens for TI-NDMM. With both drugs administrated orally, the study involved 63 patients who were randomized to receive either treatment. The primary objective was to compare their overall response rates (ORR), progression-free survival (PFS), overall survival (OS), and safety profiles.
The initial findings indicate noteworthy differences between the two regimens. The ICd group achieved an ORR of 87.1% compared to 71.9% for the RCd group after four treatment cycles. The best response rates for very good partial response (≥VGPR) were 41.9% for ICd and 31.2% for RCd, underscoring the potential of Ixazomib for improved treatment outcomes. Notably, among patients with high-risk cytogenetics, there was also a trend favoring the ICd regimen with 75% achieving ORR compared to 55.5% for the RCd group.
Despite the promising higher response rates observed with the ICd regimen, researchers noted, "Although the ICd regimen's ORR was numerically superior to the RCd regimen, it did not translate to improved survival outcomes." Median PFS was nearly identical with 22 months for ICd and 23 months for RCd, and median OS was yet to be reached, with estimated 3-year OS rates of 86.4% for ICd and 85.4% for RCd.
Safety data revealed interesting insights as well. The incidence of grade 3 or higher adverse events such as neutropenia and pneumonia was markedly lower for the ICd regimen, with only 6.5% for neutropenia compared to 31.3% for RCd. Overall, both regimens demonstrated comparable rates of treatment-related dose reductions and discontinuations—22.6% for ICd as opposed to 37.5% for RCd, indicating higher tolerability for the ICd treatment option.
This study not only reinforces the relevance of Ixazomib as part of TI-NDMM treatment but also addresses pressing needs of elderly patients who require gentler yet effective therapies. Authors remarked, "Both ICd and RCd regimens demonstrated less dose reduction and treatment discontinuation, which indicates their tolerability and feasibility for older individuals with TI-NDMM." The exploration of primary resistance through patient-specific characteristics promises future intersectional developments.
Conclusively, this clinical trial signifies the first head-to-head comparison of ICd versus RCd within this demographic. While results indicate favorable ORR with ICd, the absence of significant survival differences prompts future research initiatives to optimize treatment pathways and explore the full therapeutic potential of Ixazomib, especially for those with high-risk features.