DR LOVE: A practical clinical question, let me just ask: If this man — looking back on what happened, particularly when he got the induction treatment — could have received an oral proteasome inhibitor, specifically ixazomib, compared to the subQ, do you think that would have been to his benefit in any way? Was it in any way difficult for him to get treated?

DR RAJE: Absolutely. An all-oral regimen would be the absolute right thing for this patient. It’s going to reduce him coming to the hospital, so on and so forth.

DR LOVE: Do you think he would have valued it?

DR RAJE: I absolutely think he would have. And we have used IRd, which is the ixazomib/lenalidomide/dexamethasone combination, in a Phase II study in the up-front setting. And there is an ongoing trial. The TOURMALINE-2 trial is an ongoing trial in the up-front setting looking at IRd versus lenalidomide/dexamethasone. And for the elderly patient population, I think the triplet combination with ixazomib is what the future should really be.

DR LOVE: And it kind of gets into this general question, Rafael, that you see in oncology in general, which is when is there enough data to take action? Here you had a situation. You don’t have perfect data right now in terms of ixazomib in the up-front setting, but it would have made a difference to this patient. How are you approaching this, the issue of when you can use ixazomib as opposed to bortezomib?

DR FONSECA: Well, it’s a real challenge. And we’ll try to adapt and, to the best of our knowledge, interpret. The reality is you would never have data for anything that’s so unique for your patient. So even when we have Phase III data, we’re adapting that for the specific patient’s situation.

Now, specifically to ixazomib, I personally think that it’s a great option because of the innovation that comes with the convenience. Now, my take on ixazomib — and I may be wrong — is that we still need to work on the schedule and dose.

I don’t think it — for lack of a better word — still packs the full punch of bortezomib the way we use it. But it does so in enough of a way that we have Phase III trials that are positive in combination with lenalidomide and dexamethasone.

If we have a patient who has difficulty getting to the treatment center, who can’t drive, who we can provide this freedom from the doctor by having this oral agent — such as, arguably, with this situation — I think that would be a major plus.

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Induction, consolidation and maintenance therapy for MM

Treatment of relapsed/refractory MM

Novel approaches under investigation for MM