Rapid Readout: Routine Clinical Practice Use of IRd in Patients With Relapsed/Refractory Multiple Myeloma (The INSURE Study)

Expert perspective on the INSURE study, which pooled data from several trials to observe the real-world effectiveness of IRd in the setting of relapsed/refractory multiple myeloma.

Suzanne Lentzsch, MD, discusses data from the following study:

  • The INSURE study (INSIGHT MM, UVEA-IXA, REMIX): a pooled analysis of relapsed/refractory multiple myeloma (RRMM) patients (pts) treated with
    ixazomib-lenalidomide-dexamethasone (IRd) in routine clinical practice. (Leleu X et al. Blood. 2021;138[suppl 1]:2701).
    • Ixazomib in combination with lenalidomide and dexamethasone has been approved for the treatment of RRMM based on the results of the TOURMALINE-MM1 phase 3 study. However, outcomes in routine clinical practice often differ from data reported in clinical trials for MM therapies, being poorer for real-world versus clinical trial patients.

  • Several retrospective and prospective observational studies have shown comparable effectiveness of IRd in the second and later lines of therapy (LoTs) in the real-world setting with the efficacy observed in TOURMALINE-MM1, with median progression-free survival (PFS) ranging from 11 months to 43 months. The objective of the current analysis of a large, global dataset pooled from 3 observational studies is to investigate the effectiveness of IRd in the overall RRMM population, by LoT, and in subpopulations of patients defined by frailty status.
  • In all, 564 adults with RRMM from several clinical trials (INSIGHT, UVEA-IXA, and REMIX) were included in a pooled analysis. Primary outcome measures were time to next therapy and PFS. Secondary outcome measures included duration of therapy, overall survival, overall response rate (ORR), and safety.
  • Results/Conclusions:
    • The effectiveness of IRd in routine clinical practice (median PFS, 19.9 months; ORR, 65%) is consistent with the efficacy of IRd observed in the registrational TOURMALINE-MM1 trial (median PFS, 20.6 months; ORR, 78%), with no new safety concerns reported.
    • A very good partial response was noted among 17% of frail patients vs 42% of nonfrail patients.
    • The ORR was 70% in the 2nd LoT, 63% in the 3rd LoT, and 53% in the 4th LoT.