Study results presented at the 2021 ASH Annual Meeting provide valuable real-world data on current treatment patterns and decision-making for patients with multiple myeloma (MM). The study was presented by Amanda Ribbands, Adelphi Real World, Bollington, United Kingdom.

“With each successive line of therapy, treatment choice for patients with MM becomes increasingly complicated due to existing regimens and the lack of consensus on the standard of care for relapsed/refractory disease,” wrote Ribbands and colleagues.

“There is a need for more real-world information on current MM treatments and clinical practices. More insight into the complexity of treatment choices for MM, increasing with each [line of therapy], is also needed to better understand and inform patient treatment as their MM progresses,” they continued.

In this study, Ribbands and colleagues aimed to examine current clinical practice and decision-making for MM treatment in the real-world setting.

The Adelphi MM Disease Specific Programme™, a point-in-time survey of hematologists/oncologists in the United States, was used to obtain information on MM treatment patterns and decision-making from first-line to fourth-line therapy and beyond. The survey was conducted between August 2020 and July 2021.

A total of 63 physicians were included in the study, reporting patients who ever received or are on at the time of data collection, a specific line of therapy. Data were provided for 259 patients with first-line treatment, 186 with second-line, 120 with third-line, 60 with fourth-line, and 2 with fifth-line.

Of the patients included in the study, 66% were male with a mean age of 67.7 years. In addition, 59% of patients had Medicare for their health insurance and 32% had commercial insurance.

Triplet regimens were used in 72% of patients receiving first-line therapy, 72% receiving second-line therapy, 68% receiving third-line therapy, and 43% receiving fourth-line therapy. The top 5 triplet regimens received in the first-line setting were bortezomib plus lenalidomide and dexamethasone (VRd; n = 137, 53%), cyclophosphamide plus bortezomib and dexamethasone (CyBorD; n = 33, 13%), daratumumab plus lenalidomide and dexamethasone (DRd; n = 7, 3%), carfilzomib plus lenalidomide and dexamethasone (KRd; n = 7, 3%), and bortezomib plus doxorubicin and dexamethasone (PAd; n = 7, 3%).

The top 5 triplet regimens received in the second-line were DRd (n = 36, 19%), KRd (n = 32, 17%), daratumumab plus bortezomib and dexamethasone (DVd; n = 20, 11%), daratumumab plus pomalidomide and dexamethasone (DPd; n = 14, 8%), and CyBorD (n = 8, 4%).

The top 5 triplet regimens received in the third-line setting were KRd (n = 16, 13%), DPd (n = 13, 11%), ixazomib plus pomalidomide and dexamethasone (IPd; n = 12, 10%), elotuzumab plus pomalidomide and dexamethasone (EPd; n = 8, 7%), and DVd (n = 6, 5%). The top triplet regimen received in the fourth-line was EPd (n = 5, 8%).

Regimens including CD38-targeted agents were used across all lines of therapy, with the most frequent use in second- and third-line settings (first-line, 8%; second-line, 45%; third-line, 26%; fourth-line, 19%). Retreatment with the same drug class occurred in 53% of patients treated with a proteasome inhibitor, 50% of patients treated with immunomodulatory drugs, and 4% of patients treated with CD38-targeted treatment.

The most common reason for treatment discontinuation across all lines of therapy was disease progression or relapse (first-line, 48%; second-line, 61%; third-line, 63%; fourth-line, 100%).

The leading factors influencing physicians’ treatment choice across all lines of therapy were good clinical data regarding overall survival (OS; first-line, 59%; second-line, 65%; third-line, 52%; fourth-line, 48%) followed by better efficacy overall (first-line, 48%; second-line, 53%; third-line, 45%; fourth-line, 41%). In the third-line setting, physicians also reported high overall response rate as an important factor (24%).

The most frequent factor influencing choice of triplet regimens in the first-line (56%), second-line (65%), and third-line (50%) settings was good clinical data regarding OS. In the fourth-line setting and beyond, the most frequent factor was manageable side effects profile (43%). Other factors influencing treatment choice included long-term safety, transplant eligibility, and effective use of the treatment as part of a combination therapy.

“Interim analyses revealed a trend for use of triplet therapies across all [lines of therapy], high retreatment rate with the same drug class, and the importance of survival data and clinical efficacy as key factors influencing physician selection of treatment,” concluded Ribbands and colleagues.

Ribbands A, Gorsh B, Bailey A,  et al. Current Clinical Practice and Decision-Making in Multiple Myeloma Treatment in the United States of America: A Real-World Survey. Presented at the: 2021 Ash Annual Meeting; December 11-14, 2021; Atlanta, GA and virtual. Abstract 3001.