The National Institute for Health and Care Excellence (NICE) has recommended ixazomib (Ninlaro) with lenalidomide and dexamethasone as a treatment option for relapsed or refractory multiple myeloma.
Ixazomib in combination with lenalidomide and dexamethasone is recommended for the treatment of adults with multiple myeloma when they have previously received at least 1 line of therapy but is likely to be given to those having received 2 or 3 lines of therapy.
Recommended dose is 4 mg once a week taken orally on days 1, 8 and 15 of a 28-day cycle, accompanied by lenalidomide 25 mg once daily on days 1-21 and dexamethasone 40 mg on days 1, 8, 15 and 22.
Among those previously treated with 2-3 lines of therapy, evidence shows ixazomib (with lenalidomide + dexamethasone) to lengthen disease-free progression compared with lenalidomide + dexamethasone alone; however, the survival benefit of ixazomib (with lenalidomide + dexamethasone) over lenalidomide + dexamethasone alone has not been established. NICE does not consider it to be a life-extending treatment in terminal stages.
The drug is available within the Cancer Drugs Fund in compliance with the managed access agreement. The recommendations should not affect patients whose treatment with the drug was started before publication of the guidance.
