Dr. Bianchi on Maintenance Therapy in Multiple Myeloma

Giada Bianchi, MD, physician, Dana-Farber Cancer Institute, instructor in medicine, Harvard Medical School, discusses maintenance therapy in the treatment of patients with multiple myeloma.

Earlier this year, the phase III TOURMALINE-MM3 trial was published, which looked at the use of ixazomib (Ninlaro) as a maintenance strategy in patients with newly diagnosed disease following autologous stem cell transplant. The data from the trial show that there is about a 5-month improvement in progression-free survival (PFS) in patients who receive maintenance ixazomib versus placebo.

The trial may have been impacted by the fact that the majority of patients enrolled on the study did not receive an immunomodulatory drug (IMiD) as part of induction chemotherapy. The shorter PFS with ixazomib compared with what was seen in the study comparing lenalidomide (Revlimid) and placebo as maintenance may have been due to the fact that these patients were never exposed to lenalidomide or a similar agent, explains Bianchi.

Lenalidomide has been shown to induce deep remissions, which is critical in myeloma, she adds. However, for patients who are intolerant to lenalidomide or who have other constraints for lenalidomide, ixazomib may offer a suitable alternative.

Typically, bortezomib (Velcade) is given in combination with lenalidomide as maintenance, especially in high-risk patients. It’ll be very valuable to have an all oral proteasome inhibitor and IMiD combination to use as maintenance therapy in high-risk patients, says Bianchi. There are also data coming from the phase III TOURMALINE-MM1 study of continuous therapy with ixazomib, lenalidomide, and dexamethasone. Early data suggest that the regimen is effective in improving the prognosis of patients with high-risk features, including deletion 17p, she adds.