How many years can treatment with ixazomib be maintained?

Ixazomib is the first approved oral proteasome inhibitor and is widely used in the maintenance treatment phase of multiple myeloma (MM). It is mainly used clinically for long-term disease control in newly treated patients after completing induction therapy and autologous hematopoietic stem cell transplantation (ASCT). Compared with injectable proteasome inhibitors such as Bortezomib, the advantages of oral administration of ixazomib have significantly improved patient compliance and expanded the clinical feasibility of its long-term maintenance use.

As for the duration of treatment, the general treatment consensus is that maintenance treatment with ixazomib can last from 18 months to 36 months. Under the premise that the disease has not progressed and adverse reactions are controllable, some patients even maintain good remission after continuous use for more than 3 years. Different from traditional periodic treatment, the goal of maintenance treatment is not to completely eliminate tumor cells, but to suppress their proliferation for a long time, reduce the risk of recurrence, and delay the transformation into symptomatic progression. In recent years, with the application of residual disease monitoring technology (such as MRD detection), some patients have the opportunity to shorten the course of treatment or even consider discontinuing medication after achieving sustained deep remission (such as CR or MRD negative). However, more clinicians still prefer the "efficacy-oriented" model, that is, on the basis of good patient tolerance and stable disease, long-term maintenance can achieve better progression-free survival (PFS) and overall survival (OS) benefits.

It is worth noting that during long-term maintenance treatment with ixazomib, one still needs to be wary of cumulative toxicity, especially symptoms such as peripheral neuropathy, mild bone marrow suppression, and fatigue. It is generally recommended to conduct efficacy evaluation and toxicity monitoring every 3 months in order to adjust the dose or switch to other treatment options in a timely manner.

All in all, the duration of use of ixazomib should be comprehensively judged based on the patient's disease risk, treatment response and tolerance. Individualized extension of treatment duration will become the mainstream direction of maintenance treatment strategies in the future.

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