New Zealand Formulary
Menu Close Menu

Fewer cancers.
Better survival.
Equity for all.

Systemic Anti-Cancer Therapy Regimen Library

Home > PCN MM - ixazomib, lenalidomide and dexamethasone

PCN MM - ixazomib, lenalidomide and dexamethasone

Treatment Overview

Cycle 1 (and all further cycles) - 28 days

Cycle length:
28

Cycle details

Cycle 1 (and all further cycles) - 28 days

Medication Dose Route Days Max Duration
dexamethasone * 40 mg flat dosing oral administration 1, 8, 15,
22
ixazomib 4 mg oral administration 1, 8, 15
lenalidomide 25 mg Once daily oral administration 1 to 21

Full details

Cycle 1 (and all further cycles) - 28 days

Day: 1

Medication Dose Route Max duration Details
dexamethasone * 40 mg flat dosing oral administration
Instructions:

Take in the morning with food.
ixazomib 4 mg oral administration
Instructions:

Take ONCE a week for 3 weeks of a 4 week cycle. Take on the same day and at approximately the same time of day. Take on an empty stomach—at least one hour before OR two hours after food. Swallow whole with a glass of water.
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 2

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 3

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 4

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 5

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 6

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 7

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 8

Medication Dose Route Max duration Details
dexamethasone * 40 mg flat dosing oral administration
Instructions:

Take in the morning with food.
ixazomib 4 mg oral administration
Instructions:

Take ONCE a week for 3 weeks of a 4 week cycle. Take on the same day and at approximately the same time of day. Take on an empty stomach—at least one hour before OR two hours after food. Swallow whole with a glass of water.
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 9

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 10

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 11

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 12

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 13

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 14

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 15

Medication Dose Route Max duration Details
dexamethasone * 40 mg flat dosing oral administration
Instructions:

Take in the morning with food.
ixazomib 4 mg oral administration
Instructions:

Take ONCE a week for 3 weeks of a 4 week cycle. Take on the same day and at approximately the same time of day. Take on an empty stomach—at least one hour before OR two hours after food. Swallow whole with a glass of water.
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 16

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 17

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 18

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 19

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 20

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 21

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 22

Medication Dose Route Max duration Details
dexamethasone * 40 mg flat dosing oral administration
Instructions:

Take in the morning with food.

Additional details

Section 1: Teratogenic effects

All patients must fulfil the requirements of the pregnancy prevention risk management programme to ensure pregnant women are not exposed to lenalidomide.

Supportive Care Factors

Factor Value
Antiviral prophylaxis for herpes virus: Routine antiviral prophylaxis recommended
Emetogenicity: Minimal to low
Gastroprotection: Gastroprotection may be considered
Pneumocystis jirovecii pneumonia (PJP) prophylaxis: Routine antibiotic prophylaxis recommended
Thromboprophylaxis: Thromboprophylaxis is recommended
Tumour lysis syndrome prophylaxis: Tumour lysis syndrome prophylaxis may be considered

Antiviral prophylaxis for hepatitis B virus: Guidance is limited to high-risk anti-cancer medicines. Clinicians will need to assess individual patient risk for other anti-cancer medicines. 

References

Moreau, P., T. Masszi, N. Grzasko, et al. 2016. "Oral Ixazomib, Lenalidomide, and Dexamethasone for Multiple Myeloma." N Engl J Med 374(17):1621-1634., PMID: 27119237

Kumar, S. K., J. G. Berdeja, R. Niesvizky, et al. 2019. "Ixazomib, lenalidomide, and dexamethasone in patients with newly diagnosed multiple myeloma: long-term follow-up including ixazomib maintenance." Leukemia. , PMID: 30696949

Moreau, P., H. Pylypenko, S. Grosicki, et al. 2011. "Subcutaneous versus intravenous administration of bortezomib in patients with relapsed multiple myeloma: a randomised, phase 3, non-inferiority study." Lancet Oncol 12(5):431-440., PMID: 21507715

Carfilzomib, lenalidomide and dexamethasone for relapsed multiple myeloma.” NEJM 372(2):142-152. , PMID: 25482145

Takeda Pharmaceuticals Australia Pty Ltd Ninlaro Australian Product Information 24 February 2021 https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2016-PI-02769-1&d=20220406172310101 9Accessed 6 April 2022).

Celgene Limited Revlimid New Zealand Datasheet 27 January 2022 https://www.medsafe.govt.nz/profs/datasheet/r/revlimidcap.pdf (Accessed 31/3/2022).

Regimen details sometimes vary slightly from the published literature after recommendation by expert committee consensus.

* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.

s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.