Multiple Myeloma Coverage from Every Angle

Maintenance Therapy With Ixazomib in Newly Diagnosed Multiple Myeloma

By: Joshua D. Madera, MS
Posted: Monday, October 26, 2020

For patients with newly diagnosed multiple myeloma who are not undergoing autologous stem cell transplantation, maintenance therapy with the proteasome inhibitor ixazomib may prolong progression-free survival with tolerable toxicity, according to the phase III TOURMALINE-MM4 study published in the Journal of Clinical Oncology. Ixazomib is “the first proteasome inhibitor demonstrated in a randomized clinical trial to have single-agent efficacy for maintenance and is the first oral proteasome inhibitor option in this patient population,” explained Sagar Lonial, MD, of the Winship Cancer Institute of Emory University, Atlanta, and colleagues.

A total of 706 patients with multiple myeloma were recruited for the study. All patients had newly received their diagnosis, were not undergoing autologous stem cell transplantation and had achieved at least a partial response after 6 to 12 months of standard induction therapy. Patients were randomly assigned to receive oral ixazomib (n = 425) or a placebo (n = 281) on days 1, 8, and 15 of the 24-month treatment cycle.

The investigators reported that patients who received ixazomib demonstrated a 34.1% decreased risk of disease progression or death than those who received a placebo. This decrease was observed for 17.4 months in patients who received ixazomib and 9.4 months in patients who received the placebo. Moreover, patients who responded partially or completely post-induction demonstrated significant benefit from ixazomib treatment (hazard ratio = 0.586).

Patients treated with ixazomib had more treatment-related adverse effects than control patients (36.6% vs. 23.2%, respectively). These side effects included nausea (26.8% vs. 8.0%), vomiting (24.2% vs. 4.3%), and diarrhea (23.2% vs. 12.3%).

Disclosure: For full disclosures of the study authors, visit

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