How is Ninlaro used?
Ninlaro® (ixazomib, Takeda Oncology) is an oral agent approved for use in combination with lenalidomide (Revlimid®, Celgene) and low-dose dexamethasone for patients with multiple myeloma who have received at least one prior therapy.
What types of patients can benefit from Ninlaro?
Ninlaro has been studied in a variety of patients with multiple myeloma including:
- Patients who received one to three prior therapies
- Patients who have received three or more prior therapies (heavily pretreated)
- Patients who were refractory to their previous treatment(s)
- Patients who previously received high-dose chemotherapy and stem cell transplant
- Both younger and older patients
- Patients with reduced liver function (hepatic impairment)
- Patients with reduced kidney function (renal impairment) and patients on dialysis
Ninlaro has also been evaluated in combination with other myeloma therapies in newly diagnosed patients in early-stage clinical trials. A Phase III trial is evaluating Ninlaro in combination with Revlimid and low-dose dexamethasone in newly diagnosed myeloma.
How does Ninlaro work?
Ninlaro is a proteasome inhibitor. Proteasomes are enzymes found in cells that help the cell break down old or unwanted proteins. These proteins are split into amino acids which can then be recycled to make new proteins. Cancer cells depend on the proteasome to provide this protein metabolism (turnover) function to regulate their growth and survival. Ninlaro disrupts a cancer cells’ ability to survive by blocking the proteasome and disrupting protein metabolism. Myeloma cells may be uniquely sensitive to proteasome inhibitors because they make large amounts of protein (called M-protein) and need this recycling function to survive.
Laboratory and animal studies show that Ninlaro inhibits the growth of myeloma cells, including those that are resistant to Velcade and other anti-myeloma therapies. Ninlaro also induces myeloma cell death (apoptosis).