When choosing later line therapy for relapsed/refractory multiple myeloma (MM), physicians’ placed higher relative importance on overall survival (OS), progression-free survival (PFS), and overall response rate (ORR) and preferred a decreased risk of grade 3/4 keratopathy and thrombocytopenia, according to a study presented at the 2021 ASCO Quality Care Symposium. 

Patient age and treatment- and disease-specific factors are some of the many factors that physicians consider when selecting third-line or greater treatments for relapsed/refractory MM.

“A greater understanding of preferences that drive treatment decision-making in relapsed/refractory MM in later lines is important,” wrote Laurie Batchelder, BA, MSc, PhD, Scientific Manager at IQVIA, Danbury, CT, lead author of this study, and colleagues.

This study aimed to assess treatment preferences of hematologists/oncologists and oncologists for patients with relapsed/refractory MM in the third-line setting or greater.

Qualitative interviews with hematology oncologists and oncologists were conducted, and a pilot discrete choice experiment survey was given, testing the validity of the study attributes. The three versions of the final survey were varied in patient profiles, according to whether they were third-line, fourth-line, or fifth-line.

A total of  227 hematologists/oncologists and oncologists participated in this study and were presented with 20 discrete choice experiment choice tasks. In each task, they were asked to choose between pairs of hypothetical treatments including varying levels for each attribute: overall survival (OS), overall response rate (ORR), progression free survival (PFS), keratopathy (corneal epithelium changes with/without symptoms), thrombocytopenia, neutropenia, steroids, preparations, mode of administration, and drug regimen frequency of administration.

Multinomial logic regression was used to calculate treatment preferences for each profile. Data for fourth-line and fifth-line treatment were combined, due to patients having similar profiles.

In third-line and fourth-line or greater, OS had the highest mean relative importance of the attributes relative to other attributes, with third-line being 38.1%, and fourth-line or greater being 36.5%. The lowest relative importance in third-line and fourth-line or greater was whether the treatment required additional preparations for administration, with third-line being 1.3% and fourth-line or greater being 2.1%.

The multinomial logic regression model revealed a preference for treatments with decreased grade 3/4 keratopathy risk of 0% vs 25% (third-line: P <.0001; fourth-line or greater: P <.01). treatments with decreased grade 3/4 thrombocytopenia risk of 21% vs 60% % (third-line: P <.05; fourth-line or greater: P <.05). There were preferences for a subcutaneously administered treatment for fourth-line or great (OR 1.10, P <.05).

“In assessing treatment preferences, HemOnc/Oncs placed higher relative importance on OS, PFS, ORR, and preferred a decreased risk of grade 3/4 keratopathy and thrombocytopenia when choosing later line therapies for relapsed/refractory MM,” Dr Batchelder and colleagues concluded.

Bathcelder L, Philpott S, Divino V, et al. Physician decision-making on use of treatments for relapsed/refractory multiple myeloma (RRMM) in later lines: What drives preferences? Presented at: the 2021 ASCO Quality Care Symposium; September 25-26, 2021; Boston, MA, and virtual; Abstract 239.