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Ixazomib significantly prolongs progression-free survival in high-risk relapsed/refractory myeloma patients

Hervé Avet-Loiseau, Nizar J. Bahlis, Wee-Joo Chng, Tamas Masszi, Luisa Viterbo, Ludek Pour, Peter Ganly, Antonio Palumbo, Michele Cavo, Christian Langer, Andrzej Pluta, Arnon Nagler, Shaji Kumar, Dina Ben-Yehuda, S. Vincent Rajkumar, Jesus San-Miguel, Deborah Berg, Jianchang Lin, Helgi van de Velde, Dixie-Lee Esseltine, Alessandra di Bacco, Philippe Moreau and Paul G. Richardson

Key points

  • IRd was associated with a consistent PFS benefit versus placebo-Rd in RRMM patients with high-risk and standard-risk cytogenetics.

  • The addition of ixazomib to Rd overcomes the poor PFS associated with high-risk cytogenetics in patients with RRMM.

Abstract

Certain cytogenetic abnormalities are known to adversely impact outcomes in patients with multiple myeloma (MM). The phase 3 TOURMALINE-MM1 study demonstrated a significant improvement in progression-free survival (PFS) with ixazomib-lenalidomide-dexamethasone (IRd) compared with placebo-Rd. This pre-planned analysis assessed the efficacy and safety of IRd versus placebo-Rd according to cytogenetic risk, as assessed using fluorescence in-situ hybridization. High-risk cytogenetic abnormalities were defined as del(17p), t(4;14), and/or t(14;16); additionally, patients were assessed for 1q21 amplification. Of 722 randomized patients, 552 had cytogenetic results; 137 (25%) had high-risk cytogenetic abnormalities and 172 (32%) had 1q21 amplification alone. PFS was improved with IRd versus placebo-Rd in both high-risk and standard-risk cytogenetics subgroups: in high-risk patients, hazard ratio (HR) was 0.543 (95% confidence interval [CI], 0.321–0.918; p = .021), with median PFS of 21.4 versus 9.7 months; in standard-risk patients, HR was 0.640 (95% CI, 0.462–0.888; p = .007), with median PFS of 20.6 versus 15.6 months. This PFS benefit was consistent across subgroups with individual high-risk cytogenetic abnormalities, including patients with del(17p) (HR 0.596; 95% CI, 0.286–1.243). PFS was also longer with IRd versus placebo-Rd in patients with 1q21 amplification (HR 0.781; 95% CI, 0.492–1.240), and in the "expanded high-risk" group, defined as those with high-risk cytogenetic abnormalities and/or 1q21 amplification (HR 0.664; 95% CI, 0.474–0.928). IRd demonstrated substantial benefit compared with placebo-Rd in RRMM patients with high-risk and standard-risk cytogenetics, and improves the poor PFS associated with high-risk cytogenetic abnormalities. This trial was registered at ClinicalTrials.gov as NCT01564537.

  • Submitted June 22, 2017.
  • Accepted October 9, 2017.