Modern tactics of treatment of relapsed/refractory multiple myeloma
Summary. Multiple myeloma (MM) is a malignant neoplasm of plasma cells, which is characterized by their accumulation in the bone marrow, which leads to the destruction of bone tissue and the development of bone marrow failure. The prognosis for the survival of this patients’ group remains low, despite modern therapeutic advances. Over the past two decades, many new treatments for MM have been developed, resulting in improved 5-year survival rates for patients at all stages of the disease. However, despite advances in therapy, most patients with MM suffer from disease relapse, which limits their further treatment options and reduces the ability to control disease progression. Progress in the treatment of previously treated MM began with the appearance of available therapeutic agents of the group of proteasome inhibitors. Ixazomib is the first and only oral protease inhibitor on the pharmaceutical market of Ukraine. Studying the efficacy and safety of ixazomib in patients with relapsed/refractory (r/r) MM was conducted in the international multicenter, randomized, double-blind, placebo-controlled phase III clinical trial TOURMALINE-MM1. The study results showed that median PFS was significantly longer in the ixazomib, lenalidomide, and dexamethasone group compared with participants who received placebo, lenalidomide, and dexamethasone (20.6 months vs. 14.7 months; hazard ratio (HR) was 0.74; p=0.01). In 2021, the final data of the III phase of the TOURMALINE-MM1 study were received regarding the assessment of overall survival (OS) in patients with r/r MM who received ixazomib, lenalidomide and dexamethasone. It was shown that with an average follow-up period of 85 months, the median OS in ixazomib group was 53.6 months, and in the placebo group — 51.6 months (HR — 0.939; p=0.495). Thus, based on the results of the TOURMALINE-MM1 study, it was established that ixazomib in combination with lenalidomide and dexamethasone is an effective and safe treatment scheme of patients with r/r MM, the use of which is recommended by modern guidelines.
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