Among patients with newly diagnosed multiple myeloma (MM), adding metronomic cyclophosphamide to an all-oral ixazomib, cyclophosphamide, and dexamethasone combination does not appear to improve clinical outcomes, according to research published in The Oncologist.

In cases where any treatment in the standard combination is unusable, alternative regimens are needed. For this phase 2 study by the Brown University Oncology Group ( Identifier: NCT02412228), researchers evaluated the safety and efficacy of ixazomib, cyclophosphamide, and dexamethasone, along with metronomic cyclophosphamide dosing, among patients with newly diagnosed MM.

A total of 18 patients were screened; 12 were enrolled and included in the final analysis. Overall, 10 patients were male, the median age was 63.5 years, the median number of prior systemic therapies was 0, and 8 patients had an Eastern Cooperative Oncology Group performance status of 0.

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Owing to slow recruitment, the trial was stopped early. Analysis showed that the overall response rate was 58.3%; no complete responses were noted. The median progression-free survival was 16 months; the median overall survival was 43 months.

In the study, 50% of patients had a grade 3 or worse dermatologic event, although no cases of grade 3 or worse peripheral neuropathy were observed.

“While our sample size was limited our data do not suggest benefit of further study of this specific drug regimen in the first-line setting except in unique patient populations that may not be able to tolerate alternative treatment options,” the authors wrote in their report.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of authors’ disclosures. 


Pelcovits A, Barth P, Reagan JL, et al. Ixazomib, oral metronomic cyclophosphamide, and dexamethasone for first-line treatment of multiple myeloma: a phase II Brown University Oncology Group Study. Oncologist. Published online March 21, 2023. doi:10.1093/oncolo/oyad017