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Management of adverse events associated with ixazomib plus lenalidomide/dexamethasone in relapsed/refractory multiple myeloma.

Identifieur interne : 000743 ( PubMed/Corpus ); précédent : 000742; suivant : 000744

Management of adverse events associated with ixazomib plus lenalidomide/dexamethasone in relapsed/refractory multiple myeloma.

Auteurs : Shaji Kumar ; Philippe Moreau ; Parameswaran Hari ; Maria-Victoria Mateos ; Heinz Ludwig ; Chaim Shustik ; Tamas Masszi ; Andrew Spencer ; Roman Hájek ; Kenneth Romeril ; Irit Avivi ; Anna M. Liberati ; Monique C. Minnema ; Hermann Einsele ; Sagar Lonial ; Deborah Berg ; Jianchang Lin ; Neeraj Gupta ; Dixie-Lee Esseltine ; Paul G. Richardson

Source :

RBID : pubmed:28485007

English descriptors

Abstract

The oral proteasome inhibitor ixazomib is approved in the United States, European Union and other countries, in combination with oral lenalidomide and dexamethasone (Rd), for the treatment of patients with multiple myeloma who have received at least one prior therapy. Approval was based on the global, randomised, double-blind, placebo-controlled Phase III TOURMALINE-MM1 study of ixazomib-Rd (IRd) versus placebo-Rd in patients with relapsed/refractory multiple myeloma. IRd resulted in a significant improvement in progression-free survival versus placebo-Rd (median: 20·6 vs. 14·7 months; hazard ratio 0·74). Common toxicities observed more commonly with IRd versus placebo-Rd were thrombocytopenia, nausea, vomiting, diarrhoea, constipation, rash, peripheral neuropathy, peripheral oedema and back pain; these were generally grade 1/2 in severity except for thrombocytopenia (19% vs. 9% grade 3/4), which appeared manageable and reversible, with no differences between arms in significant bleeding or dose discontinuations. No cumulative toxicities were observed, indicating the potential feasibility of long-term IRd treatment. Safety data from TOURMALINE-MM1 are reviewed and guidance for managing clinically relevant adverse events associated with IRd is provided. Most toxicities were manageable with supportive care and dose delays or reductions as needed. Clinicians should be aware of and understand these potential side effects to optimise and prolong patient benefit.

DOI: 10.1111/bjh.14733
PubMed: 28485007

Links to Exploration step

pubmed:28485007

Le document en format XML

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<name sortKey="Avivi, Irit" sort="Avivi, Irit" uniqKey="Avivi I" first="Irit" last="Avivi">Irit Avivi</name>
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<nlm:affiliation>Department of Haematology and Bone Marrow Transplantation, Tel Aviv Medical Centre, Tel Aviv, Israel.</nlm:affiliation>
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<name sortKey="Liberati, Anna M" sort="Liberati, Anna M" uniqKey="Liberati A" first="Anna M" last="Liberati">Anna M. Liberati</name>
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<nlm:affiliation>University of Perugia, SC Oncoematologia AO S. Maria di Terni, Terni, Italy.</nlm:affiliation>
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<name sortKey="Minnema, Monique C" sort="Minnema, Monique C" uniqKey="Minnema M" first="Monique C" last="Minnema">Monique C. Minnema</name>
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<nlm:affiliation>Department of Haematology, UMC Utrecht Cancer Centre, Utrecht, The Netherlands.</nlm:affiliation>
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<name sortKey="Einsele, Hermann" sort="Einsele, Hermann" uniqKey="Einsele H" first="Hermann" last="Einsele">Hermann Einsele</name>
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<nlm:affiliation>Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany.</nlm:affiliation>
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<name sortKey="Lonial, Sagar" sort="Lonial, Sagar" uniqKey="Lonial S" first="Sagar" last="Lonial">Sagar Lonial</name>
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<nlm:affiliation>Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA.</nlm:affiliation>
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<name sortKey="Berg, Deborah" sort="Berg, Deborah" uniqKey="Berg D" first="Deborah" last="Berg">Deborah Berg</name>
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<nlm:affiliation>Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA.</nlm:affiliation>
</affiliation>
</author>
<author>
<name sortKey="Gupta, Neeraj" sort="Gupta, Neeraj" uniqKey="Gupta N" first="Neeraj" last="Gupta">Neeraj Gupta</name>
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<nlm:affiliation>Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA.</nlm:affiliation>
</affiliation>
</author>
<author>
<name sortKey="Esseltine, Dixie Lee" sort="Esseltine, Dixie Lee" uniqKey="Esseltine D" first="Dixie-Lee" last="Esseltine">Dixie-Lee Esseltine</name>
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<title level="j">British journal of haematology</title>
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<term>Administration, Oral</term>
<term>Adult</term>
<term>Aged</term>
<term>Aged, 80 and over</term>
<term>Antineoplastic Combined Chemotherapy Protocols (adverse effects)</term>
<term>Antineoplastic Combined Chemotherapy Protocols (therapeutic use)</term>
<term>Boron Compounds (administration & dosage)</term>
<term>Boron Compounds (adverse effects)</term>
<term>Dexamethasone (administration & dosage)</term>
<term>Dexamethasone (adverse effects)</term>
<term>Dose-Response Relationship, Drug</term>
<term>Double-Blind Method</term>
<term>Drug Administration Schedule</term>
<term>Drug Eruptions (etiology)</term>
<term>Drug Eruptions (therapy)</term>
<term>Follow-Up Studies</term>
<term>Glycine (administration & dosage)</term>
<term>Glycine (adverse effects)</term>
<term>Glycine (analogs & derivatives)</term>
<term>Hematologic Diseases (chemically induced)</term>
<term>Hematologic Diseases (therapy)</term>
<term>Humans</term>
<term>Leukocyte Count</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Multiple Myeloma (drug therapy)</term>
<term>Nausea (chemically induced)</term>
<term>Nausea (therapy)</term>
<term>Peripheral Nervous System Diseases (chemically induced)</term>
<term>Peripheral Nervous System Diseases (therapy)</term>
<term>Platelet Count</term>
<term>Thalidomide (administration & dosage)</term>
<term>Thalidomide (adverse effects)</term>
<term>Thalidomide (analogs & derivatives)</term>
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<term>Hematologic Diseases</term>
<term>Nausea</term>
<term>Peripheral Nervous System Diseases</term>
<term>Vomiting</term>
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<term>Multiple Myeloma</term>
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<term>Drug Eruptions</term>
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<term>Antineoplastic Combined Chemotherapy Protocols</term>
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<term>Hematologic Diseases</term>
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<keywords scheme="MESH" xml:lang="en">
<term>Administration, Oral</term>
<term>Adult</term>
<term>Aged</term>
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<term>Dose-Response Relationship, Drug</term>
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<term>Drug Administration Schedule</term>
<term>Follow-Up Studies</term>
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<term>Middle Aged</term>
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<div type="abstract" xml:lang="en">The oral proteasome inhibitor ixazomib is approved in the United States, European Union and other countries, in combination with oral lenalidomide and dexamethasone (Rd), for the treatment of patients with multiple myeloma who have received at least one prior therapy. Approval was based on the global, randomised, double-blind, placebo-controlled Phase III TOURMALINE-MM1 study of ixazomib-Rd (IRd) versus placebo-Rd in patients with relapsed/refractory multiple myeloma. IRd resulted in a significant improvement in progression-free survival versus placebo-Rd (median: 20·6 vs. 14·7 months; hazard ratio 0·74). Common toxicities observed more commonly with IRd versus placebo-Rd were thrombocytopenia, nausea, vomiting, diarrhoea, constipation, rash, peripheral neuropathy, peripheral oedema and back pain; these were generally grade 1/2 in severity except for thrombocytopenia (19% vs. 9% grade 3/4), which appeared manageable and reversible, with no differences between arms in significant bleeding or dose discontinuations. No cumulative toxicities were observed, indicating the potential feasibility of long-term IRd treatment. Safety data from TOURMALINE-MM1 are reviewed and guidance for managing clinically relevant adverse events associated with IRd is provided. Most toxicities were manageable with supportive care and dose delays or reductions as needed. Clinicians should be aware of and understand these potential side effects to optimise and prolong patient benefit.</div>
</front>
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<AbstractText>The oral proteasome inhibitor ixazomib is approved in the United States, European Union and other countries, in combination with oral lenalidomide and dexamethasone (Rd), for the treatment of patients with multiple myeloma who have received at least one prior therapy. Approval was based on the global, randomised, double-blind, placebo-controlled Phase III TOURMALINE-MM1 study of ixazomib-Rd (IRd) versus placebo-Rd in patients with relapsed/refractory multiple myeloma. IRd resulted in a significant improvement in progression-free survival versus placebo-Rd (median: 20·6 vs. 14·7 months; hazard ratio 0·74). Common toxicities observed more commonly with IRd versus placebo-Rd were thrombocytopenia, nausea, vomiting, diarrhoea, constipation, rash, peripheral neuropathy, peripheral oedema and back pain; these were generally grade 1/2 in severity except for thrombocytopenia (19% vs. 9% grade 3/4), which appeared manageable and reversible, with no differences between arms in significant bleeding or dose discontinuations. No cumulative toxicities were observed, indicating the potential feasibility of long-term IRd treatment. Safety data from TOURMALINE-MM1 are reviewed and guidance for managing clinically relevant adverse events associated with IRd is provided. Most toxicities were manageable with supportive care and dose delays or reductions as needed. Clinicians should be aware of and understand these potential side effects to optimise and prolong patient benefit.</AbstractText>
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