Duration of treatment (DoT) of multiple myeloma regimens in patients (pts) with relapsed or refractory multiple myeloma (RRMM): findings in US clinical practice settings
Clara Chen1, Christopher Yasenchak2, Ravi Potluri3, Hemanth Kanakamedala3, Sandip Ranjan4, Eros Papademetriou3, Hitesh Bhandari4, Jasdeep Mann4, Catherine Davis1
1Bristol-Myers Squibb, Princeton, NJ, USA; 2Willamette Valley Cancer Institute and Research Center/US Oncology Research, Eugene, OR, USA; 3SmartAnalyst Inc., New York, NY, USA; 4SmartAnalyst India Pvt. Ltd, Gurgaon, India
Background: Regimens with key agents such as elotuzumab (elo), daratumumab (dara), carfilzomib (carf), ixazomib (ixa), and pomalidomide (pom) have improved survival in RRMM. As RRMM is typically treated until disease progression, if treatment is tolerated, DoT may reflect regimen efficacy and safety. Real-world DoT of key-agent regimens and their impact on clinical outcomes are unknown.
Methods: Adults listed in the Explorys US database with ≥1 MM diagnosis after Jan 1, 2010 were followed from diagnosis date to end of follow-up. Pts with RRMM had ≥1 prior line of therapy (LoT; any drug[s] taken ≤28 d from start of therapy to end of those drugs[s]/start of salvage therapy). Median progression-free survival (PFS), DoT, and time to next treatment (TTNT; time between start of current LoT and start of next LoT) by Kaplan-Meier analyses, and early discontinuations within 28 d, are reported per LoT.
Results: 1734 LoTs consisting of elo (n=65), dara (n=321), carf (n=609), ixa (n=172), and pom (n=567) regimens were identified for 854 pts with RRMM (median age 64-66 y; 43-54% male). Median number of prior LoTs was 3-4. Median follow-up was 28-39 mo. For pts with second-line (2L) and 2L or more (2L+) treatment, elo had the longest median (95% CI) PFS (2L: 11.8 [3.0, 15.9] mo, n=12; 2L+: 5.4 [4.2, 10.8] mo, n=65) and DoT (2L: 6.3 [2.6, 15.5] mo, n=12; 2L+: 4.6 [2.8, 5.7] mo, n=65). In pts with 2L+ treatment, median (95% CI) TTNT was significantly longer for elo vs dara (5.4 [4.2, 10.8] mo, n=65 vs 3.8 [3.3, 5.2] mo, n=321; p<0.05). Significantly fewer early discontinuations occurred with elo vs other regimens in patients with 2L+ treatment (8% vs 14-30%; p<0.005).
Conclusions: In real-world clinical practice, elo regimens generally had longer median DoT vs dara-, carf-, ixa-, and pom-based regimens. Increased DoT may be due to the favorable efficacy and safety of elo, despite longer treatment exposure.
Study funding: BMS