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Bergin K, Yuen F, Wallington-Beddoe C, Kalff A, Sirdesai S, Reynolds J, Spencer A. A phase II trial of continuous ixazomib, thalidomide and dexamethasone for relapsed and/or refractory multiple myeloma: the Australasian Myeloma Research Consortium (AMaRC) 16-02 trial. Br J Haematol 2021; 194:580-586. [PMID: 33991421 DOI: 10.1111/bjh.17504] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/12/2021] [Accepted: 04/01/2021] [Indexed: 01/24/2023]
Abstract
We evaluated the efficacy and tolerability of continuous ixazomib-thalidomide-dexamethasone (ITd: 4 mg, day 1, 8, 15; 100 mg daily; and 40 mg weekly). A total of 39 patients with relapsed/refractory multiple myeloma (RRMM) aged ≥18 years with one to three prior lines of therapy were enrolled from two tertiary centres in Victoria and South Australia, Australia. The overall response rate (ORR) was 56·4% with a clinical benefit rate of 71·8%. The median progression-free survival was 13·8 months [95% confidence interval (CI) 8·2-22·2] and median overall survival was not reached. The median time to best response and duration of response was 3·7 months (95% CI 2·8-10·5) and 18·4 months (95% CI 10·2-31·0) respectively. Prior immunomodulatory drug (IMID) exposure was associated with a lower ORR (40% vs. 73·7%, P = 0·03). Survival outcomes in patients with prior proteasome inhibitor (PI) and/or IMID exposure were similar. Patients received a median (range) of 11 (1-31) cycles of therapy and six patients (15%) remained on therapy at the time of final analysis. Grade 3/4 haematological and non-haematological adverse events were reported in 7·7% and 20·6% of patients respectively. ITd dose reductions were required in 15·4%, 48·7% and 35·9% of patients respectively. The present study demonstrates promising effectiveness and tolerability of ITd as an affordable all-oral PI-IMID approach for RRMM.
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Affiliation(s)
- Krystal Bergin
- Alfred Health-Monash University, Melbourne, Victoria, Australia
| | - Flora Yuen
- Alfred Health, Melbourne, Victoria, Australia
| | - Craig Wallington-Beddoe
- Flinders Medical Centre, Bedford Park, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.,Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, South Australia, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Anna Kalff
- Alfred Health-Monash University, Melbourne, Victoria, Australia
| | | | - John Reynolds
- Alfred Health-Monash University, Melbourne, Victoria, Australia
| | - Andrew Spencer
- Alfred Health-Monash University, Melbourne, Victoria, Australia
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Grosicki S, Simonova M, Spicka I, Pour L, Kriachok I, Gavriatopoulou M, Pylypenko H, Auner HW, Leleu X, Doronin V, Usenko G, Bahlis NJ, Hajek R, Benjamin R, Dolai TK, Sinha DK, Venner CP, Garg M, Gironella M, Jurczyszyn A, Robak P, Galli M, Wallington-Beddoe C, Radinoff A, Salogub G, Stevens DA, Basu S, Liberati AM, Quach H, Goranova-Marinova VS, Bila J, Katodritou E, Oliynyk H, Korenkova S, Kumar J, Jagannath S, Moreau P, Levy M, White D, Gatt ME, Facon T, Mateos MV, Cavo M, Reece D, Anderson LD, Saint-Martin JR, Jeha J, Joshi AA, Chai Y, Li L, Peddagali V, Arazy M, Shah J, Shacham S, Kauffman MG, Dimopoulos MA, Richardson PG, Delimpasi S. Once-per-week selinexor, bortezomib, and dexamethasone versus twice-per-week bortezomib and dexamethasone in patients with multiple myeloma (BOSTON): a randomised, open-label, phase 3 trial. Lancet 2020; 396:1563-1573. [PMID: 33189178 DOI: 10.1016/s0140-6736(20)32292-3] [Citation(s) in RCA: 157] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/25/2020] [Accepted: 08/06/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Selinexor combined with dexamethasone has shown activity in patients with heavily pre-treated multiple myeloma. In a phase 1b/2 study, the combination of oral selinexor with bortezomib (a proteasome inhibitor) and dexamethasone induced high response rates with low rates of peripheral neuropathy, the main dose-limiting toxicity of bortezomib. We aimed to evaluate the clinical benefit of weekly selinexor, bortezomib, and dexamethasone versus standard bortezomib and dexamethasone in patients with previously treated multiple myeloma. METHODS This phase 3, randomised, open-label trial was done at 123 sites in 21 countries. Patients aged 18 years or older, who had multiple myeloma, and who had previously been treated with one to three lines of therapy, including proteasome inhibitors, were randomly allocated (1:1) to receive selinexor (100 mg once per week), bortezomib (1·3 mg/m2 once per week), and dexamethasone (20 mg twice per week), or bortezomib (1·3 mg/m2 twice per week for the first 24 weeks and once per week thereafter) and dexamethasone (20 mg four times per week for the first 24 weeks and twice per week thereafter). Randomisation was done using interactive response technology and stratified by previous proteasome inhibitor therapy, lines of treatment, and multiple myeloma stage. The primary endpoint was progression-free survival in the intention-to-treat population. Patients who received at least one dose of study treatment were included in the safety population. This trial is registered at ClinicalTrials.gov, NCT03110562. The trial is ongoing, with 55 patients remaining on randomised therapy as of Feb 20, 2020. FINDINGS Of 457 patients screened for eligibility, 402 were randomly allocated-195 (49%) to the selinexor, bortezomib, and dexamethasone group and 207 (51%) to the bortezomib and dexamethasone group-and the first dose of study medication was given between June 6, 2017, and Feb 5, 2019. Median follow-up durations were 13·2 months [IQR 6·2-19·8] for the selinexor, bortezomib, and dexamethasone group and 16·5 months [9·4-19·8] for the bortezomib and dexamethasone group. Median progression-free survival was 13·93 months (95% CI 11·73-not evaluable) with selinexor, bortezomib, and dexamethasone and 9·46 months (8·11-10·78) with bortezomib and dexamethasone (hazard ratio 0·70 [95% CI 0·53-0·93], p=0·0075). The most frequent grade 3-4 adverse events were thrombocytopenia (77 [39%] of 195 patients in the selinexor, bortezomib, and dexamethasone group vs 35 [17%] of 204 in the bortezomib and dexamethasone group), fatigue (26 [13%] vs two [1%]), anaemia (31 [16%] vs 20 [10%]), and pneumonia (22 [11%] vs 22 [11%]). Peripheral neuropathy of grade 2 or above was less frequent with selinexor, bortezomib, and dexamethasone (41 [21%] patients) than with bortezomib and dexamethasone (70 [34%] patients; odds ratio 0·50 [95% CI 0·32-0·79], p=0·0013). 47 (24%) patients in the selinexor, bortezomib, and dexamethasone group and 62 (30%) in the bortezomib and dexamethasone group died. INTERPRETATION A once-per-week regimen of selinexor, bortezomib, and dexamethasone is a novel, effective, and convenient treatment option for patients with multiple myeloma who have received one to three previous lines of therapy. FUNDING Karyopharm Therapeutics.
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Affiliation(s)
| | - Maryana Simonova
- Institute of Blood Pathology and Transfusion Medicine, National Academy of Medical Sciences of Ukraine, Lviv, Ukraine
| | - Ivan Spicka
- Charles University and General Hospital, Prague, Czech Republic
| | - Ludek Pour
- Clinic of Internal Medicine-Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | | | - Maria Gavriatopoulou
- Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Halyna Pylypenko
- Department of Hematology, Cherkassy Regional Oncological Center, Cherkassy, Ukraine
| | | | - Xavier Leleu
- Department of Hematology, CHU la Miletrie and Inserm CIC 1402, Poitiers, France
| | | | - Ganna Usenko
- City Clinical Hospital 4 of Dnipro City Council, City Hematology Center, Dnipro, Ukraine
| | - Nizar J Bahlis
- Charbonneau Cancer Research Institute, University of Calgary, Calgary, AB, Canada
| | - Roman Hajek
- Department of Hemato-oncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Reuben Benjamin
- Kings College NHS Foundation Trust, Kings College London, London, UK
| | - Tuphan K Dolai
- Nil Ratan Sircar Medical College and Hospital, Kolkata, India
| | - Dinesh K Sinha
- State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Patna, India
| | | | - Mamta Garg
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Artur Jurczyszyn
- Department of Hematology, Jagiellonian University Medical College, Kraków, Poland
| | - Pawel Robak
- Department of Hematology, Copernicus Memorial Hospital, Medical University of Lodz, Lodz, Poland
| | - Monica Galli
- Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | | | - Galina Salogub
- Chemotherapy of Oncology Diseases-Bone Marrow Transplantation Department 1, Almazov National Medical Research Centre, Ministry of Health of Russia, St Petersburg, Russia
| | - Don A Stevens
- Norton Cancer Institute, St Matthews Campus, Louisville, KY, USA
| | - Supratik Basu
- New Cross Hospital, Royal Wolverhampton NHS Trust and University of Wolverhampton, Wolverhampton, UK
| | - Anna M Liberati
- Oncohematology Hospital S Maria Terni, University of Perugia, Terni, Italy
| | - Hang Quach
- University of Melbourne, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Vesselina S Goranova-Marinova
- University Hospital "Sv Georgi" EAD, Clinic of Clinical Hematology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Jelena Bila
- Clinic for Hematology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Eirini Katodritou
- Hematology Department, Theagenion Cancer Hospital, Thessaloniki, Greece
| | - Hanna Oliynyk
- Department of Hematology, Vinnytsia M I Pyrohov Regional Clinical Hospital, Vinnytsia, Ukraine
| | - Sybiryna Korenkova
- Bone Marrow Transplantation Department, Kyiv Bone Marrow Transplantation Center, Kyiv, Ukraine
| | | | - Sundar Jagannath
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Moshe Levy
- Baylor University Medical Center, Dallas, TX, USA
| | - Darrell White
- Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Moshe E Gatt
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Thierry Facon
- CHU Lille Service des Maladies du Sang F-59000, Lille, France
| | | | - Michele Cavo
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università degli Studi, Bologna, Italy
| | - Donna Reece
- University Health Network-Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Larry D Anderson
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | | | - Yi Chai
- Karyopharm Therapeutics, Newton, MA, USA
| | | | | | | | - Jatin Shah
- Karyopharm Therapeutics, Newton, MA, USA
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