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NCT01564537

A Phase 3 Study Comparing Oral Ixazomib Plus Lenalidomide and Dexamethasone Versus Placebo Plus Lenalidomide and Dexamethasone in Adult Participants With Relapsed and/or Refractory Multiple Myeloma

Completed Phase 3 Results posted Last updated 10 March 2023
What this trial tests

Phase 3 trial testing Ixazomib in Relapsed Multiple Myeloma in 722 participants. Completed in 8 February 2022.

Timeline
1 August 2012
Primary endpoint
1 October 2014
8 February 2022

Quick facts

Lead sponsorTakeda
PhasePhase 3
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingquadruple
Primary purposetreatment
Enrollment722
Start date1 August 2012
Primary completion1 October 2014
Estimated completion8 February 2022
Sites24 locations across Canada, United States

Drugs / interventions tested

Conditions studied

Sponsor

Takeda — full company profile →

Who can join

18 and older, any sex, with Relapsed Multiple Myeloma or Refractory Multiple Myeloma. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Progression Free Survival (PFS) as Assessed by the Independent Review Committee (IRC) Primary · From date of randomization until disease progression or death up to approximately 27 months (approximate median follow-up 15 months)

Progression Free Survival (PFS) is defined as the time from the date of randomization to the date of first documentation of disease progression (PD) or death due to any cause, whichever occurs first. Response including PD was assessed by independent review committee (IRC) using the International Myeloma Working Group (IMWG) response criteria. PD requires 1 of the following: Increase of ≥ 25% from nadir in: Serum M-component (absolute increase ≥ 0.5 g/dl); Urine M-component (absolute increase ≥ 200 mg/24 hours); In patients without measurable serum and urine M-protein levels the difference betw

GroupValue95% CI
Ixazomib+ Lenalidomide + Dexamethasone20.617.02 – NA
Placebo + Lenalidomide + Dexamethasone14.712.91 – 17.58
Overall Survival (OS) Secondary · From date of randomization until death (up to approximately 97 months)

Overall survival is defined as the time from the date of randomization to the date of death. Participants without documentation of death at the time of the analysis were censored at the date when they were last known to be alive.

GroupValue95% CI
Ixazomib+ Lenalidomide + Dexamethasone53.649.25 – 62.95
Placebo + Lenalidomide + Dexamethasone51.644.78 – 59.14
Overall Survival in High-Risk Participants Carrying Deletion 17 [Del(17)] Secondary · From the time of screening until disease progression and thereafter every 12 weeks until death or study termination (up to approximately 97 months)

Overall survival is defined as the time from the date of randomization to the date of death. The high-risk participants whose myeloma carried del(17) subgroup was defined as the cases reported as positive for del(17) by the central laboratory combined with those cases that lacked a central laboratory result but with known del (17) by local laboratory. Participants without documentation of death at the time of the analysis were censored at the date when they were last known to be alive. Data is only reported high-risk participants with Del(17).

GroupValue95% CI
Ixazomib+ Lenalidomide + Dexamethasone42.227.56 – 56.74
Placebo + Lenalidomide + Dexamethasone29.416.99 – 44.22
Overall Response Rate (ORR) as Assessed by the IRC Secondary · Day 1 of each cycle (every 4 weeks) until disease progression up to approximately 27 months(approximate median follow-up 15 months)

ORR was defined as the percentage of participants with Complete Response (CR) including stringent complete response (sCR), very good partial response (VGPR) and Partial Response (PR) assessed by the IRC using IMWG criteria. Percentages are rounded off to single decimal.

GroupValue95% CI
Ixazomib+ Lenalidomide + Dexamethasone78.3
Placebo + Lenalidomide + Dexamethasone71.5
Percentage of Participants With Complete Response (CR) and Very Good Partial Response (VGPR) as Assessed by the IRC Secondary · Day 1 of each cycle (every 4 weeks) until disease progression up to approximately 27 months (approximate median follow-up 15 months)

Response was assessed by the IRC using International Myeloma Working Group (IMWG) Criteria. CR is defined as negative immunofixation on the serum and urine and; disappearance of any soft tissue plasmacytomas and; \< 5% plasma cells in bone marrow. VGPR is defined as Serum and urine M-protein detectable by immunofixation but not on electrophoresis or 90% or greater reduction in serum M-protein plus urine M-protein level \< 100 mg per 24 hours. Percentages are rounded off to single decimal.

GroupValue95% CI
Ixazomib + Lenalidomide + Dexamethasone48.1
Placebo + Lenalidomide + Dexamethasone39.0
Duration of Response (DOR) Secondary · Day 1 of each cycle (every 4 weeks) until disease progression up to approximately 38 months

DOR was measured as the time in months from the date of first documentation of a confirmed response of PR or better (CR \[including sCR\] + PR+ VGPR) to the date of the first documented disease progression (PD) among participants who responded to the treatment. Response was assessed by the investigator using International Myeloma Working Group (IMWG) Criteria.

GroupValue95% CI
Ixazomib+ Lenalidomide + Dexamethasone26.022.51 – NA
Placebo + Lenalidomide + Dexamethasone21.717.77 – NA
Time to Progression (TTP) as Assessed by the IRC Secondary · Day 1 of each cycle (every 4 weeks) until disease progression up to approximately 27 months (approximate median follow-up 15 months)

TTP was measured as the time in months from the first dose of study treatment to the date of the first documented progressive disease (PD) as assessed by the IRC using IMWG criteria.

GroupValue95% CI
Ixazomib+ Lenalidomide + Dexamethasone22.418.73 – 27.66
Placebo + Lenalidomide + Dexamethasone17.614.52 – 20.27
Number of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs) Secondary · From the date of signing of the informed consent form through 30 days after the last dose of study drug up to approximately 115 months

Eastern Cooperative Oncology Group (ECOG) performance score, laboratory values, vital sign measurements and reported adverse events (AEs) were collected and assessed to evaluate the safety of therapy throughout the study. An AE is defined as any untoward medical occurrence in a clinical investigation participant administered a drug; it does not necessarily have to have a causal relationship with this treatment. An AE can therefore be any unfavorable and unintended sign (example, a clinically significant abnormal laboratory finding), symptom, or disease temporally associated with the use of a d

TEAEs
GroupValue95% CI
Ixazomib+ Lenalidomide + Dexamethasone359
Placebo + Lenalidomide + Dexamethasone357
SAEs
GroupValue95% CI
Ixazomib+ Lenalidomide + Dexamethasone205
Placebo + Lenalidomide + Dexamethasone201
Number of Participants With Change From Baseline in Pain Response Secondary · Baseline and end of treatment (EOT) (up to approximately 38 months)

Pain response was defined as 30% reduction from Baseline in Brief Pain Inventory-Short Form (BPI-SF) worst pain score over the last 24 hours without an increase in analgesic (oral morphine equivalents) use at 2 consecutive evaluations. The BPI-SF contains 15 items designed to capture the pain severity ("worst," "least," "average," and "now" \[current pain\]), pain location, medication to relieve the pain, and the interference of pain with various daily activities including general activity, mood, walking activity, normal work, relations with other people, sleep, and enjoyment of life. The pain

Baseline
GroupValue95% CI
Ixazomib+ Lenalidomide + Dexamethasone345
Placebo + Lenalidomide + Dexamethasone351
EOT
GroupValue95% CI
Ixazomib+ Lenalidomide + Dexamethasone145
Placebo + Lenalidomide + Dexamethasone153
Change From Baseline in the European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life (QOL) Questionnaire (EORTC-QLQ-C30) Secondary · Baseline, EOT and follow-up (up to approximately 97 months)

The EORTC-QLQ-C30 is a 30-question tool used to assess the overall quality of life in cancer participants. It consists of 15 domains: 1 global health status (GHS) scale, 5 functional scales (Physical, Role, Cognitive, Emotional, Social), and 9 symptom scales/items (Fatigue, Nausea and Vomiting, Pain, Dyspnea, Sleep Disturbance, Appetite Loss, Constipation, Diarrhea, Financial Impact).The EORTC-QLQ-C30 Global Health Status/QOL Scale is scored between 0 and 100, where higher scores indicate better Global Health Status/QOL. Negative changes from baseline indicate deterioration in QOL or functioni

Global Health Index: Baseline
GroupValue95% CI
Ixazomib+ Lenalidomide + Dexamethasone58.4± 22.60
Placebo + Lenalidomide + Dexamethasone56.4± 22.12
Global Health Index: End of Treatment
GroupValue95% CI
Ixazomib+ Lenalidomide + Dexamethasone-6.0± 24.6
Placebo + Lenalidomide + Dexamethasone-6.0± 23.85
Global Health Index: Last Follow-up
GroupValue95% CI
Placebo + Lenalidomide + Dexamethasone16.7± NA
Physical Functioning: Baseline
GroupValue95% CI
Ixazomib+ Lenalidomide + Dexamethasone70.0± 21.74
Placebo + Lenalidomide + Dexamethasone67.3± 23.54
Physical Functioning: EOT
GroupValue95% CI
Ixazomib+ Lenalidomide + Dexamethasone-4.7± 22.61
Placebo + Lenalidomide + Dexamethasone-6.2± 23.36
Physical Functioning: Last Follow-up
GroupValue95% CI
Placebo + Lenalidomide + Dexamethasone0.0± NA
Role Functioning: Baseline
GroupValue95% CI
Ixazomib+ Lenalidomide + Dexamethasone68.4± 28.75
Placebo + Lenalidomide + Dexamethasone64.4± 30.24
Role Functioning: EOT
GroupValue95% CI
Ixazomib+ Lenalidomide + Dexamethasone-8.6± 31.27
Placebo + Lenalidomide + Dexamethasone-8.6± 32.90
Change From Baseline in the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Multiple Myeloma Module (QLQ-MY-20) Secondary · Baseline, EOT and follow-up (up to approximately 97 months)

The EORTC-QLQ-MY-20 is a patient-completed, 20-question quality of life questionnaire that has 4 independent subscales, 2 functional subscales (body image, future perspective), and 2 symptoms scales (disease symptoms and side-effects of treatment). The participant answers questions about their health during the past week using a 4-point scale where 1=Not at All to 4=Very Much. A negative change from Baseline indicates improvement. Scores are linearly transformed to a 0-100 scale. Higher scores on the symptom scales (e.g. Disease Symptoms, Side Effects of Treatment) represent higher levels of s

Disease Symptoms: Baseline
GroupValue95% CI
Ixazomib+ Lenalidomide + Dexamethasone29.71± 20.850
Placebo + Lenalidomide + Dexamethasone30.41± 23.072
Disease Symptoms: EOT
GroupValue95% CI
Ixazomib+ Lenalidomide + Dexamethasone-2.35± 20.752
Placebo + Lenalidomide + Dexamethasone-2.58± 21.372
Disease Symptoms: Last Follow-up
GroupValue95% CI
Ixazomib+ Lenalidomide + Dexamethasone1.11± NA
Side Effects of Treatment: Baseline
GroupValue95% CI
Ixazomib+ Lenalidomide + Dexamethasone17.23± 14.289
Placebo + Lenalidomide + Dexamethasone17.97± 14.682
Side Effects of Treatment: EOT
GroupValue95% CI
Ixazomib+ Lenalidomide + Dexamethasone4.52± 14.435
Placebo + Lenalidomide + Dexamethasone4.43± 13.955
Side Effects of Treatment: Last Follow-up
GroupValue95% CI
Placebo + Lenalidomide + Dexamethasone37.04± NA
Body Image: Baseline
GroupValue95% CI
Ixazomib+ Lenalidomide + Dexamethasone78.00± 29.259
Placebo + Lenalidomide + Dexamethasone79.48± 27.233
Body Image: EOT
GroupValue95% CI
Ixazomib+ Lenalidomide + Dexamethasone-0.27± 29.102
Placebo + Lenalidomide + Dexamethasone-5.38± 29.368
OS in High-Risk Participants Secondary · From the time of screening until disease progression and thereafter every 12 weeks until death or study termination (up to approximately 97 months)

Overall survival (OS) is defined as the time from the date of randomization to the date of death. High-risk participants are defined as participants carrying cytogenic abnormalities: del(17), translocation t(4;14), or t(14;16) as reported by the central laboratory combined with those cases that lacked a central laboratory result but with known del (17), t(4;14), or t(14;16) by local laboratory. Cytogenetic abnormalities of del(13) and +1q are not included in the analysis. Participants without documentation of death at the time of the analysis were censored at the date when they were last known

GroupValue95% CI
Ixazomib+ Lenalidomide + Dexamethasone46.934.04 – 64.53
Placebo + Lenalidomide + Dexamethasone30.924.77 – 42.25

Adverse events — posted to ClinicalTrials.gov

Time frame: From the date of signing of the informed consent form through 30 days after the last dose of study drug up to approximately 115 months. Reporting threshold: 5%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Ixazomib+ Lenalidomide + Dexamethasone
Serious: 205/361 (57%)
Deaths: 250/361
Placebo + Lenalidomide + Dexamethasone
Serious: 202/359 (56%)
Deaths: 251/359

Serious adverse events (326 terms)

ReactionSystemIxazomib+ Lenalidomide + D…Placebo + Lenalidomide + D…
PneumoniaInfections and infestations
PyrexiaGeneral disorders
DiarrhoeaGastrointestinal disorders
AnaemiaBlood and lymphatic system disorders
BronchitisInfections and infestations
Febrile neutropeniaBlood and lymphatic system disorders
Pulmonary embolismRespiratory, thoracic and mediastinal disorders
Back painMusculoskeletal and connective tissue disorders
InfluenzaInfections and infestations
Atrial fibrillationCardiac disorders
CataractEye disorders
Deep vein thrombosisVascular disorders
Respiratory tract infectionInfections and infestations
Squamous cell carcinoma of skinNeoplasms benign, malignant and unspecified (incl cysts and polyps)
Acute kidney injuryRenal and urinary disorders
Cardiac failureCardiac disorders
Lower respiratory tract infectionInfections and infestations
SyncopeNervous system disorders
ThrombocytopeniaBlood and lymphatic system disorders
Urinary tract infectionInfections and infestations
Cholecystitis acuteHepatobiliary disorders
GastroenteritisInfections and infestations
Myocardial infarctionCardiac disorders
Pathological fractureMusculoskeletal and connective tissue disorders
SepsisInfections and infestations
Other adverse events (80 terms — click to expand)

ReactionSystemIxazomib+ Lenalidomide + D…Placebo + Lenalidomide + D…
DiarrhoeaGastrointestinal disorders
ConstipationGastrointestinal disorders
AnaemiaBlood and lymphatic system disorders
NauseaGastrointestinal disorders
FatigueGeneral disorders
NeutropeniaBlood and lymphatic system disorders
InsomniaPsychiatric disorders
Muscle spasmsMusculoskeletal and connective tissue disorders
Back painMusculoskeletal and connective tissue disorders
Oedema peripheralGeneral disorders
Upper respiratory tract infectionInfections and infestations
ThrombocytopeniaBlood and lymphatic system disorders
VomitingGastrointestinal disorders
NasopharyngitisInfections and infestations
Peripheral sensory neuropathyNervous system disorders
ArthralgiaMusculoskeletal and connective tissue disorders
BronchitisInfections and infestations
CoughRespiratory, thoracic and mediastinal disorders
PyrexiaGeneral disorders
AstheniaGeneral disorders
CataractEye disorders
HypokalaemiaMetabolism and nutrition disorders
DizzinessNervous system disorders
HeadacheNervous system disorders
Pain in extremityMusculoskeletal and connective tissue disorders
Decreased appetiteMetabolism and nutrition disorders
PneumoniaInfections and infestations
PruritusSkin and subcutaneous tissue disorders
DyspnoeaRespiratory, thoracic and mediastinal disorders
Urinary tract infectionInfections and infestations
FallInjury, poisoning and procedural complications
Musculoskeletal chest painMusculoskeletal and connective tissue disorders
TremorNervous system disorders
Abdominal painGastrointestinal disorders
Platelet count decreasedInvestigations
Weight decreasedInvestigations
Neuropathy peripheralNervous system disorders
Bone painMusculoskeletal and connective tissue disorders
ConjunctivitisInfections and infestations
Rash maculo-papularSkin and subcutaneous tissue disorders

Most-reported serious reactions: Pneumonia, Pyrexia, Diarrhoea, Anaemia, Bronchitis, Febrile neutropenia, Pulmonary embolism, Back pain.

Data from ClinicalTrials.gov NCT01564537 adverse events section.

Sponsor's own description

The purpose of this study is to determine whether the addition of oral ixazomib to the background therapy of lenalidomide and dexamethasone improves progression free survival (PFS) in participants with relapsed and/or refractory multiple myeloma (RRMM).

Publications & conference data

8 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Oral Ixazomib, Lenalidomide, and Dexamethasone for Multiple Myeloma.
    Moreau P, Masszi T, Grzasko N, Bahlis NJ, et al · · 2016 · cited 787× · PMID 27119237 · DOI 10.1056/nejmoa1516282
  2. Proteasome inhibitors in cancer therapy.
    Manasanch EE, Orlowski RZ. · · 2017 · cited 743× · PMID 28117417 · DOI 10.1038/nrclinonc.2016.206
  3. NF-κB signaling in inflammation and cancer.
    Zhang T, Ma C, Zhang Z, Zhang H, et al · · 2021 · cited 386× · PMID 34977871 · DOI 10.1002/mco2.104
  4. VTD is superior to VCD prior to intensive therapy in multiple myeloma: results of the prospective IFM2013-04 trial.
    Moreau P, Hulin C, Macro M, Caillot D, et al · · 2016 · cited 191× · PMID 27002117 · DOI 10.1182/blood-2016-01-693580
  5. Phase 1 study of twice-weekly ixazomib, an oral proteasome inhibitor, in relapsed/refractory multiple myeloma patients.
    Richardson PG, Baz R, Wang M, Jakubowiak AJ, et al · · 2014 · cited 162× · PMID 24920586 · DOI 10.1182/blood-2014-01-548826
  6. Phase 1 study of weekly dosing with the investigational oral proteasome inhibitor ixazomib in relapsed/refractory multiple myeloma.
    Kumar SK, Bensinger WI, Zimmerman TM, Reeder CB, et al · · 2014 · cited 154× · PMID 24904120 · DOI 10.1182/blood-2014-01-548941
  7. Proteasome inhibitors - molecular basis and current perspectives in multiple myeloma.
    Kubiczkova L, Pour L, Sedlarikova L, Hajek R, et al · · 2014 · cited 139× · PMID 24712303 · DOI 10.1111/jcmm.12279
  8. Targeting ubiquitination for cancer therapies.
    Morrow JK, Lin HK, Sun SC, Zhang S. · · 2015 · cited 91× · PMID 26630263 · DOI 10.4155/fmc.15.148

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