The following article features coverage from the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting. Click here to read more of Hematology Advisor‘s conference coverage.

A dexamethasone-ixazomib doublet therapy does not improve progression-free survival (PFS) over a dexamethasone-pomalidomide combination among patients with lenalidomide-refractory, proteasome inhibitor–exposed multiple myeloma (MM), according to research presented at the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting.

Patients with MM frequently undergo several lines of therapy, and lenalidomide is often used in first-line combinations. Because of this, it is important to use lenalidomide-free options in the second line and thereafter, and to attempt to use less toxic lines among older patients.

For this randomized phase 2 trial ( Identifier: NCT03170882), researchers evaluated the safety and efficacy of ixazomib and dexamethasone vs pomalidomide and dexamethasone among 122 patients with MM who were both lenalidomide-refractory and who had received at least 2 prior lines of therapy. Randomization was carried out on a 3:2 ratio between the ixazomib and pomalidomide groups, respectively.

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Overall, 73 and 49 patients were randomly assigned to the ixazomib and pomalidomide groups, respectively. The median ages in the ixazomib and pomalidomide groups were 72 and 68 years, 25% and 22% of patients had stage III disease, and 52% and 53% of patients had undergone at least 3 prior lines of therapy, respectively.

Data cutoff was on May 31, 2020; the median follow-ups in the ixazomib and pomalidomide groups were 15.3 months and 17.3 months, respectively. At this point, 19% of patients in the ixazomib group and 20% of patients in the pomalidomide group were still receiving treatment; the primary reasons for treatment discontinuation were progressive disease (47% in the ixazomib group vs 57% in the pomalidomide group) and adverse events (AEs; 23% vs 12%, respectively).

The median PFS in the ixazomib group was 7.1 months vs 4.8 months in the pomalidomide group (hazard ratio, 0.847; P =.477). Thirteen percent of patients in both groups died during the study period.

Grade 3 or worse AEs occurred in 69% of patients in the ixazomib group and in 81% of those in the pomalidomide group; 51% and 53% of AEs were, respectively, serious.

Disclosure: Some [or one] study author(s) declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Read more of Hematology Advisor’s coverage of the 2021 ASCO Annual Meeting by visiting the conference page.


Dimopoulos MA, Schjesvold F, Doronin V, et al. Oral ixazomib-dexamethasone versus oral pomalidomide-dexamethasone for lenalidomide-refractory, proteasome inhibitor-exposed multiple myeloma (MM) patients: a global, multicenter, randomized, open-label, phase 2 trial. J Clin Oncol. 2021;39:(suppl 15; abstr 8020). doi:10.1200/JCO.2021.39.15_suppl.8020