DR LONIAL: She actually was a delightful lady that came to us from the southern part of the state, lived about 3 hours away. And one of the things that we learned about her was, during her transplant process, the travel back and forth between there and us was a bit of a challenge. So when we got her to a maintenance with single-agent lenalidomide, for a month or two she did well. But then she just decided she didn’t want to be on maintenance therapy. She didn’t want to come see us that often.

And so she went about 18 — probably closer to 2 years unmaintained after an autotransplant and then developed not just biochemical relapse but progressive anemia, causing us to want to try and get her started on salvage therapy. She’d received RVd as the initial therapy and did well but did have a little bit of neuropathy with the bortezomib, which is now down to just minimal Grade 1. And so for her, being able to not have to come into the office very often was an important part of the decision-making process for her, at least when she had the opportunity to make that decision.

And so when we went through the menu of potential treatment options for her, the all-oral combination of ixazomib with lenalidomide and dexamethasone was the option she really wanted, she favored.

DR LOVE: And how is she doing? What’s her current status?

DR LONIAL: Yes. She’s about 6 months in now and has achieved a VGPR. She’s tolerating therapy well. We’re beginning to dial down her dex. She is 75 years old, and so keeping them on 40 mg of dex once a week can be a little bit challenging. But she’s coming up once a month and seeing us and doing okay.

DR LOVE: And any GI toxicity? And what have you observed in general in terms of ixazomib, in terms of side effects?

DR LONIAL: Yes. It’s interesting. In the up-front setting, we’ve seen some GI toxicity that actually is mitigated by the dex, which seems to help a little bit. In the maintenance setting, when we’ve tried to use it there at full dose, we’ve had a little bit of trouble giving 4 mg in the very beginning. But if you start with 3 for a couple of cycles and then work your way up, you can get to 4 without significant issues.

Most of the skin rash and nausea that was seen was seen at the higher doses of ixazomib. So at the dose that was settled on now, the fixed dose, it’s a much lower incidence.

DR LOVE: What’s been reported and what have you observed in terms of peripheral neuropathy with ixazomib?

DR LONIAL: So it’s there. I won’t say that it’s zero, but the best example I have is somebody on the Phase I with ixazomib who had Grade 3 neuropathy from bortezomib. And I really had to sit down with her over and over again when I said, “This is the cousin of bortezomib” to get her on the trial, but she did. And she never had any further neuropathy and was on for over 4 years. So if you have it with one, you’re not going to have it necessarily, with the other. And while it’s there, it’s probably about 20% all neuropathy with ixazomib, most of it Grade 1 — very, very little Grade 3 at all.

Non-Hodgkin lymphoma (NHL), Hodgkin lymphoma and chronic lymphocytic leukemia (CLL)

Acute and chronic leukemias and myeloproliferative neoplasms

Multiple myeloma (MM)