| Literature DB >> 29054911 |
Hervé Avet-Loiseau1, Nizar J Bahlis2, Wee-Joo Chng3, Tamas Masszi4,5, Luisa Viterbo6, Ludek Pour7, Peter Ganly8, Antonio Palumbo9, Michele Cavo10, Christian Langer11, Andrzej Pluta12, Arnon Nagler13, Shaji Kumar14, Dina Ben-Yehuda15, S Vincent Rajkumar14, Jesus San-Miguel16, Deborah Berg17, Jianchang Lin17, Helgi van de Velde17, Dixie-Lee Esseltine17, Alessandra di Bacco17, Philippe Moreau18, Paul G Richardson19.
Abstract
Certain cytogenetic abnormalities are known to adversely impact outcomes in patients with multiple myeloma (MM). The phase 3 TOURMALINE-MM1 study demonstrated a significant improvement in progression-free survival (PFS) with ixazomib-lenalidomide-dexamethasone (IRd) compared with placebo-lenalidomide-dexamethasone (placebo-Rd). This preplanned analysis assessed the efficacy and safety of IRd vs placebo-Rd according to cytogenetic risk, as assessed using fluorescence in situ hybridization. High-risk cytogenetic abnormalities were defined as del(17p), t(4;14), and/or t(14;16); additionally, patients were assessed for 1q21 amplification. Of 722 randomized patients, 552 had cytogenetic results; 137 (25%) had high-risk cytogenetic abnormalities and 172 (32%) had 1q21 amplification alone. PFS was improved with IRd vs placebo-Rd in both high-risk and standard-risk cytogenetics subgroups: in high-risk patients, the hazard ratio (HR) was 0.543 (95% confidence interval [CI], 0.321-0.918; P = .021), with median PFS of 21.4 vs 9.7 months; in standard-risk patients, HR was 0.640 (95% CI, 0.462-0.888; P = .007), with median PFS of 20.6 vs 15.6 months. This PFS benefit was consistent across subgroups with individual high-risk cytogenetic abnormalities, including patients with del(17p) (HR, 0.596; 95% CI, 0.286-1.243). PFS was also longer with IRd vs placebo-Rd in patients with 1q21 amplification (HR, 0.781; 95% CI, 0.492-1.240), and in the "expanded high-risk" group, defined as those with high-risk cytogenetic abnormalities and/or 1q21 amplification (HR, 0.664; 95% CI, 0.474-0.928). IRd demonstrated substantial benefit compared with placebo-Rd in relapsed and/or refractory MM (RRMM) patients with high-risk and standard-risk cytogenetics, and improves the poor PFS associated with high-risk cytogenetic abnormalities. This trial was registered at www.clinicaltrials.gov as #NCT01564537.Entities:
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Year: 2017 PMID： 29054911 DOI： 10.1182/blood-2017-06-791228
Source DB: PubMed Journal: Blood ISSN： 0006-4971 Impact factor: 22.113