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NCT01850524

IXAZOMIB Plus Lenalidomide and Dexamethasone Versus Placebo Plus Lenalidomide and Dexamethasone in Adult Patients With Newly Diagnosed Multiple Myeloma

Completed Phase 3 Results posted Last updated 21 July 2023
What this trial tests

Phase 3 trial testing Ixazomib in Multiple Myeloma in 705 participants. Completed in 24 June 2022.

Timeline
29 April 2013
Primary endpoint
2 December 2019
24 June 2022

Quick facts

Lead sponsorMillennium Pharmaceuticals, Inc.
PhasePhase 3
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingquadruple
Primary purposetreatment
Enrollment705
Start date29 April 2013
Primary completion2 December 2019
Estimated completion24 June 2022
Sites147 locations across France, New Zealand, Russia, Belgium, South Korea, Canada, United States

Drugs / interventions tested

Conditions studied

Sponsor

Millennium Pharmaceuticals, Inc. — full company profile →

Who can join

18 and older, any sex, with 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) Primary · Up to approximately 79 months

PFS was defined as the time from the date of randomization to the date of first documentation of progressive disease (PD) or death due to any cause according to International Myeloma Working Group (IMWG) criteria whichever occurs first. PD required one of the following: Increase of \>=25% from nadir in: Serum M-component and/or (the absolute increase must be \>=0.5 g/dL); Urine M-component and/or (the absolute increase must be \>=200 mg/24 hours); in participants without measurable serum and urine M-protein levels: the difference between involved and uninvolved free light chain (FLC) levels (a

GroupValue95% CI
Placebo + LenDex21.819.65 – 30.78
Ixazomib + LenDex35.326.45 – 43.70
Overall Survival (OS) Secondary · From the date of randomization to death due to any cause (Up to approximately 9 years)

OS was defined as the time from the date of randomization to the date of death. Participants without documented death at the time of analysis are censored at the date last known to be alive.

GroupValue95% CI
Placebo + LenDexNA58.71 – NA
Ixazomib + LenDexNA63.18 – NA
Complete Response (CR) Rate Secondary · Up to approximately 9 years

CR rate was defined as the percentage of participants who achieve CR assessed by an IRC relative to the intent-to-treat (ITT) population during the treatment period. Percentage of participants with CR, as assessed by IMWG disease assessment criteria were reported. CR was defined as negative immunofixation of serum and urine along with the disappearance of any soft tissue plasmacytomas and \<5 % plasma cells (PC's) in bone marrow.

GroupValue95% CI
Placebo + LenDex14
Ixazomib + LenDex26
Pain Response Rate as Assessed by the Brief Pain Inventory- Short Form (BPI-SF) and Analgesic Use Secondary · Up to approximately 9 years

Pain response rate was defined as percentage of participants with pain response. Pain response was defined as the occurrence of at least a 30% reduction from baseline in BPI-SF worst pain score over the last 24 hours without an increase in analgesic use for 2 consecutive measurements \> 28 days apart, were reported. Brief Pain Inventory - Short Form (m-BPI-SF) is a participant rated 11-point Likert rating scale ranged from 0 (no pain) to 10 (worst pain imaginable). Percentages are rounded off to the nearest single decimal.

GroupValue95% CI
Placebo + LenDex51.3
Ixazomib + LenDex50.5
Overall Response Rate (ORR) Secondary · Up to approximately 9 years

ORR was defined as the percentage of participants who achieved CR + partial response (PR) + very good partial response (VGPR) (including sCR) or better relative to the ITT population during treatment period. CR was defined as negative immunofixation of serum and urine along with the disappearance of any soft tissue plasmacytomas and \<5 % PC's in bone marrow. PR was defined as ≥50% reduction of serum M-protein and reduction in 24-hour urinary M-protein by ≥90% along with ≥50% reduction in the size of soft tissue plasmacytomas. VGPR was defined as ≥90% in serum M-component plus urine M-componen

GroupValue95% CI
Placebo + LenDex80
Ixazomib + LenDex82
Time to Response Secondary · Up to approximately 9 years

Time to response was defined as the time from the date of randomization to the first documentation of PR or better, as measured by IMWG criteria.

GroupValue95% CI
Placebo + LenDex1.871.15 – 1.87
Ixazomib + LenDex1.020.99 – 1.08
Duration of Response Secondary · Up to approximately 9 years

Duration of response was measured as the time from the date of first documentation of PR or better to the date of first documented progression (PD) for responders, as measured by IMWG criteria.

GroupValue95% CI
Placebo + LenDex37.525.69 – 50.27
Ixazomib + LenDex50.639.98 – NA
Time to Progression (TTP) Secondary · Up to approximately 9 years

Time to progression was defined as the time from randomization to the date of first documented disease progression.

GroupValue95% CI
Placebo + LenDex26.821.22 – 37.91
Ixazomib + LenDex45.831.84 – 56.25
Progression Free Survival (PFS)-2 Secondary · Up to approximately 9 years

PFS2 was defined as the time from the date of randomization to the date of documentation of disease progression on the subsequent line of anticancer therapy, as assessed by the investigator in accordance with IMWG criteria, or death due to any cause, whichever occurs first.

GroupValue95% CI
Placebo + LenDex52.245.21 – 61.90
Ixazomib + LenDex63.254.70 – NA
Number of Participants With Shifts From Baseline to Worst Value in Eastern Cooperative Oncology Group (ECOG) Performance Score Secondary · Up to approximately 9 years

Eastern Cooperative Oncology Group (ECOG) scale score ranged from 0 to 5, where 0 indicated normal activity and 5 indicated death. The data is reported for those categories where at least 1 participant had worst post-baseline value for each ECOG score.

Baseline Score 0, Post-Baseline Score 0
GroupValue95% CI
Placebo + LenDex23
Ixazomib + LenDex23
Baseline Score 0, Post-Baseline Score 1
GroupValue95% CI
Placebo + LenDex57
Ixazomib + LenDex52
Baseline Score 0, Post-Baseline Score 2
GroupValue95% CI
Placebo + LenDex20
Ixazomib + LenDex23
Baseline Score 0, Post-Baseline Score 3
GroupValue95% CI
Placebo + LenDex2
Ixazomib + LenDex10
Baseline Score 1, Post-Baseline Score 0
GroupValue95% CI
Placebo + LenDex1
Ixazomib + LenDex1
Baseline Score 1, Post-Baseline Score 1
GroupValue95% CI
Placebo + LenDex96
Ixazomib + LenDex104
Baseline Score 1, Post-Baseline Score 2
GroupValue95% CI
Placebo + LenDex72
Ixazomib + LenDex57
Baseline Score 1, Post-Baseline Score 3
GroupValue95% CI
Placebo + LenDex18
Ixazomib + LenDex9
Number of Participants With Treatment-emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs) Secondary · From the date of randomization through 30 days after the last dose of study drug up to end of study (up to approximately 9 years)

An AE was any untoward medical occurrence in a participant administered a medicinal investigational drug. The untoward medical occurrence does not necessarily have to have a causal relationship with treatment. An SAE is any untoward medical occurrence that results in death; is life-threatening; requires inpatient hospitalization or prolongation of present hospitalization; results in persistent or significant disability/incapacity; is a congenital anomaly/birth defect or is a medically important event that may not be immediately life-threatening or result in death or hospitalization, but may je

TEAEs
GroupValue95% CI
Placebo + LenDex (Exposure Up to 18 Cycles)160
Ixazomib+ LenDex (Exposure Up to 18 Cycles)163
Placebo + LenDex (Exposure ≥19 Cycles)189
Ixazomib + LenDex (Exposure ≥19 Cycles)191
SAEs
GroupValue95% CI
Placebo + LenDex (Exposure Up to 18 Cycles)105
Ixazomib+ LenDex (Exposure Up to 18 Cycles)119
Placebo + LenDex (Exposure ≥19 Cycles)119
Ixazomib + LenDex (Exposure ≥19 Cycles)125
Number of Participants With Abnormal Serum Chemistry and Hematology Laboratory Values Based on Treatment-emergent Adverse Events (TEAEs) Secondary · From the date of randomization through 30 days after the last dose of study drug up to end of study (up to approximately 9 years)

The laboratory values assessment included serum chemistry and hematology. The Serum chemistry assessment included blood urea nitrogen (BUN), creatinine, bilirubin (total), urate, lactate dehydrogenase, phosphate, albumin, alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), glucose, sodium, potassium, calcium, chloride, carbon dioxide (CO2), magnesium, thyroid stimulating hormone (TSH). Hematology assessment included hemoglobin, hematocrit, platelet (count), leukocytes with differential neutrophils (ANC). Participants with abnormal serum chemistry labor

Hypokalaemia
GroupValue95% CI
Placebo + LenDex (Exposure Up to 18 Cycles)16
Ixazomib+ LenDex (Exposure Up to 18 Cycles)33
Placebo + LenDex (Exposure ≥19 Cycles)33
Ixazomib + LenDex (Exposure ≥19 Cycles)39
Blood creatinine increased
GroupValue95% CI
Placebo + LenDex (Exposure Up to 18 Cycles)9
Ixazomib+ LenDex (Exposure Up to 18 Cycles)6
Placebo + LenDex (Exposure ≥19 Cycles)12
Ixazomib + LenDex (Exposure ≥19 Cycles)16
Hypophosphataemia
GroupValue95% CI
Placebo + LenDex (Exposure Up to 18 Cycles)2
Ixazomib+ LenDex (Exposure Up to 18 Cycles)9
Placebo + LenDex (Exposure ≥19 Cycles)3
Ixazomib + LenDex (Exposure ≥19 Cycles)9
Hypomagnesaemia
GroupValue95% CI
Placebo + LenDex (Exposure Up to 18 Cycles)8
Ixazomib+ LenDex (Exposure Up to 18 Cycles)6
Placebo + LenDex (Exposure ≥19 Cycles)11
Ixazomib + LenDex (Exposure ≥19 Cycles)15
Hyponatraemia
GroupValue95% CI
Placebo + LenDex (Exposure Up to 18 Cycles)7
Ixazomib+ LenDex (Exposure Up to 18 Cycles)10
Placebo + LenDex (Exposure ≥19 Cycles)8
Ixazomib + LenDex (Exposure ≥19 Cycles)7
Hyperglycaemia
GroupValue95% CI
Placebo + LenDex (Exposure Up to 18 Cycles)4
Ixazomib+ LenDex (Exposure Up to 18 Cycles)7
Placebo + LenDex (Exposure ≥19 Cycles)16
Ixazomib + LenDex (Exposure ≥19 Cycles)6
Hypocalcaemia
GroupValue95% CI
Placebo + LenDex (Exposure Up to 18 Cycles)13
Ixazomib+ LenDex (Exposure Up to 18 Cycles)6
Placebo + LenDex (Exposure ≥19 Cycles)12
Ixazomib + LenDex (Exposure ≥19 Cycles)4
Hyperkalaemia
GroupValue95% CI
Placebo + LenDex (Exposure Up to 18 Cycles)3
Ixazomib+ LenDex (Exposure Up to 18 Cycles)7
Placebo + LenDex (Exposure ≥19 Cycles)3
Ixazomib + LenDex (Exposure ≥19 Cycles)3

Adverse events — posted to ClinicalTrials.gov

Time frame: From the date of randomization through 30 days after the last dose of study drug up to end of study (up to approximately 9 years). Reporting threshold: 5%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Placebo + LenDex (Exposure Up to 18 Cycles)
Serious: 105/160 (66%)
Deaths: 107/160
Ixazomib+ LenDex (Exposure Up to 18 Cycles)
Serious: 119/163 (73%)
Deaths: 95/163
Placebo + LenDex (Exposure ≥19 Cycles)
Serious: 119/189 (63%)
Deaths: 63/189
Ixazomib + LenDex (Exposure ≥19 Cycles)
Serious: 125/191 (65%)
Deaths: 63/191

Serious adverse events (360 terms)

ReactionSystemPlacebo + LenDex (Exposure…Ixazomib+ LenDex (Exposure…Placebo + LenDex (Exposure…Ixazomib + LenDex (Exposur…
Peripheral sensory neuropathyNervous system disorders
Decreased appetiteMetabolism and nutrition disorders
PneumoniaInfections and infestations
Pathological fractureMusculoskeletal and connective tissue disorders
SyncopeNervous system disorders
Basal cell carcinomaNeoplasms benign, malignant and unspecified (incl cysts and polyps)
DehydrationMetabolism and nutrition disorders
DiarrhoeaGastrointestinal disorders
Acute kidney injuryRenal and urinary disorders
Pulmonary embolismRespiratory, thoracic and mediastinal disorders
Urinary tract infectionInfections and infestations
BronchitisInfections and infestations
Squamous cell carcinoma of skinNeoplasms benign, malignant and unspecified (incl cysts and polyps)
General physical health deteriorationGeneral disorders
Cardiac failure congestiveCardiac disorders
DyspnoeaRespiratory, thoracic and mediastinal disorders
AnaemiaBlood and lymphatic system disorders
Deep vein thrombosisVascular disorders
Confusional statePsychiatric disorders
SepsisInfections and infestations
Septic shockInfections and infestations
GastroenteritisInfections and infestations
Prostate cancerNeoplasms benign, malignant and unspecified (incl cysts and polyps)
Small intestinal obstructionGastrointestinal disorders
PyrexiaGeneral disorders
Other adverse events (126 terms — click to expand)

ReactionSystemPlacebo + LenDex (Exposure…Ixazomib+ LenDex (Exposure…Placebo + LenDex (Exposure…Ixazomib + LenDex (Exposur…
DiarrhoeaGastrointestinal disorders
Oedema peripheralGeneral disorders
ConstipationGastrointestinal disorders
Peripheral sensory neuropathyNervous system disorders
ArthralgiaMusculoskeletal and connective tissue disorders
NauseaGastrointestinal disorders
BronchitisInfections and infestations
NasopharyngitisInfections and infestations
InsomniaPsychiatric disorders
FatigueGeneral disorders
Back painMusculoskeletal and connective tissue disorders
VomitingGastrointestinal disorders
AstheniaGeneral disorders
AnaemiaBlood and lymphatic system disorders
CataractEye disorders
CoughRespiratory, thoracic and mediastinal disorders
Muscle spasmsMusculoskeletal and connective tissue disorders
Pain in extremityMusculoskeletal and connective tissue disorders
Upper respiratory tract infectionInfections and infestations
NeutropeniaBlood and lymphatic system disorders
Decreased appetiteMetabolism and nutrition disorders
FallInjury, poisoning and procedural complications
Rash maculo-papularSkin and subcutaneous tissue disorders
HypokalaemiaMetabolism and nutrition disorders
DyspnoeaRespiratory, thoracic and mediastinal disorders
Abdominal painGastrointestinal disorders
PruritusSkin and subcutaneous tissue disorders
DizzinessNervous system disorders
HeadacheNervous system disorders
Weight decreasedInvestigations
PyrexiaGeneral disorders
MyalgiaMusculoskeletal and connective tissue disorders
DysgeusiaNervous system disorders
ThrombocytopeniaBlood and lymphatic system disorders
Dry skinSkin and subcutaneous tissue disorders
Urinary tract infectionInfections and infestations
Abdominal pain upperGastrointestinal disorders
HypertensionVascular disorders
Rash macularSkin and subcutaneous tissue disorders
TremorNervous system disorders

Most-reported serious reactions: Peripheral sensory neuropathy, Decreased appetite, Pneumonia, Pathological fracture, Syncope, Basal cell carcinoma, Dehydration, Diarrhoea.

Data from ClinicalTrials.gov NCT01850524 adverse events section.

Sponsor's own description

The purpose of this study is to provide continued access to ixazomib and/or lenalidomide to participants who are continuing to have clinical benefit and to continue collecting relevant safety data to monitor safety in participants with Newly Diagnosed Multiple Myeloma (NDMM) who are not eligible for stem cell transplant.

Publications & conference data

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

  1. Proteasome inhibitors in cancer therapy.
    Manasanch EE, Orlowski RZ. · · 2017 · cited 743× · PMID 28117417 · DOI 10.1038/nrclinonc.2016.206
  2. 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
  3. 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
  4. 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
  5. A phase 2 study of modified lenalidomide, bortezomib and dexamethasone in transplant-ineligible multiple myeloma.
    O'Donnell EK, Laubach JP, Yee AJ, Chen T, et al · · 2018 · cited 123× · PMID 29740809 · DOI 10.1111/bjh.15261
  6. A phase 1/2 study of the oral proteasome inhibitor ixazomib in relapsed or refractory AL amyloidosis.
    Sanchorawala V, Palladini G, Kukreti V, Zonder JA, et al · · 2017 · cited 97× · PMID 28550039 · DOI 10.1182/blood-2017-03-771220
  7. Developments in continuous therapy and maintenance treatment approaches for patients with newly diagnosed multiple myeloma.
    Dimopoulos MA, Jakubowiak AJ, McCarthy PL, Orlowski RZ, et al · · 2020 · cited 87× · PMID 32054831 · DOI 10.1038/s41408-020-0273-x
  8. Spotlight on ixazomib: potential in the treatment of multiple myeloma.
    Muz B, Ghazarian RN, Ou M, Luderer MJ, et al · · 2016 · cited 87× · PMID 26811670 · DOI 10.2147/dddt.s93602

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