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Ixazomib (Ninlaro) is the first oral proteasome inhibitor for multiple myeloma, enabling an all-oral triplet with lenalidomide and dexamethasone.
Ixazomib is an oral boronate proteasome inhibitor that reversibly blocks the beta-5 chymotrypsin-like site of the 20S proteasome, causing misfolded-protein stress and apoptosis in myeloma cells. Taken once weekly, it allows an all-oral triplet with lenalidomide and dexamethasone for patients with multiple myeloma after at least one prior therapy. TOURMALINE-MM1 (2016) showed median progression-free survival of 20.6 versus 14.7 months when ixazomib was added to lenalidomide-dexamethasone in relapsed disease, and approval followed in the US in 2015 and the EU in 2016. The maintenance trials TOURMALINE-MM3 and MM4 showed modest progression-free survival gains. It causes less neuropathy than bortezomib but is less potent than carfilzomib, so it is often chosen for convenience or frailty rather than depth of response. For a newcomer, ixazomib is the proteasome inhibitor you can take at home.
Ball-and-stick model from PubChem 2D record (no 3D conformer available). PubChem record
Reversible inhibitor of the β5 chymotrypsin-like site of the 20S proteasome; weekly oral dosing.
1.Ixazomib slips into a pocket on its target.
Background: ADC sequencing, Antigen escape (antigen loss, lineage switch), BCG-unresponsive, Castration-resistant prostate cancer (CRPC), Circulating tumour DNA (ctDNA). Also on OnCo: Resistance: how tumours escape each drug class · Lines of therapy.
Oral, self-administered, so it is a Part D drug: covered through a stand-alone Part D plan or Medicare Advantage drug benefit, usually on the specialty tier with 25 to 33% coinsurance until the annual cap ($2,000 in 2025, $2,100 in 2026).
Covered for FDA-labelled and NCCN-listed uses, but almost always behind prior authorisation confirming diagnosis, biomarker and line of therapy; dispensed through a specialty pharmacy.
Part D out-of-pocket capped at $2,000 (2025) / $2,100 (2026). Medicare patients cannot use manufacturer co-pay cards; charity funds (PAN, HealthWell, CancerCare) and the Extra Help subsidy are the routes.
Sources: Medicare.gov: Drug coverage (Part D) · Medicare.gov: Costs for Medicare drug coverage (annual out-of-pocket cap). Not medical or financial advice; verify with your plan.
Sources: NICE TA505 · NHS England Cancer Drugs Fund list · SMC advice: ixazomib. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.
| Region | Year | Indication |
|---|---|---|
| US | 2015 | Multiple myeloma after ≥1 prior therapy, with lenalidomide and dexamethasone |
| EU | 2016 | Same |
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Query for this drug: (TITLE:"Ixazomib" OR ABSTRACT:"Ixazomib" OR TITLE:"Ninlaro" OR ABSTRACT:"Ninlaro") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Ixazomib, not a curated reading list.
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