Dr. Ghobrial on Triplet Regimen in Smoldering Myeloma

Irene Ghobrial, MD, professor, Harvard Medical School, physician, Dana-Farber Cancer Institute, discusses the combination of ixazomib (Ninlaro), lenalidomide (Revlimid), and dexamethasone in smoldering multiple myeloma.

Smoldering myeloma is a very intriguing area of research, because there is a huge debate on whether or not patients should receive treatment early, says Ghobrial. The trial is based on additional studies that have evaluated lenalidomide and dexamethasone versus observation, as well as an ECOG study of lenalidomide alone versus observation. However, lenalidomide alone or in combination with dexamethasone may not be enough for patients with high-risk multiple myeloma.

Researchers of this study wanted to add a proteasome inhibitor that gives a high response rate but has less toxicity and can be used easily in the United States. In the trial, investigators treated 53 patients with a combination of ixazomib, lenalidomide, and dexamethasone. Results showed that there has been very deep remission, with a 100% overall response rate and ≥50% of patients achieving complete remissions or very good partial remissions. The follow-up is 15 months and no disease progression has been reported to date.

This could be an optimal regimen that is associated with minimal toxicity, high response rates, and is all oral for patients with high-risk smoldering multiple myeloma, concludes Ghobrial.