Liang Zhao, Xiao He, Mingyang Deng, Yun Yuan, Zhiyu Su, Zhongqi Ding, Youping Liao, Chanjuan Shen, Zhongjun Huo, Zimian Luo, Zhiqin Li, Limei Fu, Ping Zhu, Xiangling Feng, Shuping Chen, Yanjuan He, Yan Zhu
These findings suggest that initiating therapy with 3 mg ixazomib is both clinically viable and effective, potentially alleviating the economic burden for MM patients.
BACKGROUND: Multiple myeloma (MM) is an incurable hematologic malignancy, requiring sustained therapeutic management to mitigate disease recurrence. Ixazomib, a first-generation oral proteasome inhibitor, has exhibited substantial clinical efficacy and is widely employed in clinical practice. According to prescribing guidelines, ixazomib is typically administered at an initial dose of 4 mg weekly for 3 weeks, with dose reduction to 3 mg weekly in the event of adverse effects. Prior exposure-response analyses have confirmed that both 3 and 4 mg doses reside within the clinically effective range. This study aims to assess the comparative efficacy and toxicity profiles of 3 versus 4 mg ixazomib in MM.
METHODS: We performed a retrospective analysis of 207 MM patients undergoing ixazomib-based therapy across six medical centers. Patients were stratified into three subgroups: initial treatment, in-class transition, and maintenance/continuation therapy group. Additionally, patients were categorized into two cohorts according to ixazomib dosage: 3 or 4 mg. Demographic characteristics, baseline clinical features, and therapeutic outcomes were compared between the 3 and 4 mg cohorts.
RESULTS: Our results indicate that 3 and 4 mg ixazomib demonstrate equivalent efficacy in induction, class-switch, and maintenance/continuation therapy across most clinical scenarios in Chinese MM patients. Subgroup analysis within the in-class transition cohort revealed that patients with RISS Stage 3 disease exhibited prolonged progression-free survival in the 4 mg group. Furthermore, patients with an ECOG performance status of one to two achieved enhanced overall survival with the 4 mg dose. The overall adverse event rates were comparable between the two dose groups. Notably, during the induction phase, the 4 mg group exhibited a significantly higher incidence of Grades 1-2 vomiting (p = 0.016).
CONCLUSIONS: These findings suggest that initiating therapy with 3 mg ixazomib is both clinically viable and effective, potentially alleviating the economic burden for MM patients.