EVOLVING TREATMENT PATTERNS IN NON-STEM CELL TRANSPLANT (NSCT) NEWLY DIAGNOSED MULTIPLE MYELOMA (NDMM): RESULTS FROM A REAL-WORLD CHART REVIEW IN FRANCE, GERMANY, AND THE UK
Author(s): ,
Mohamad Mohty
Affiliations:
Institut national de la santé et de la recherche médicale,Paris,France
,
Dorothy Romanus
Affiliations:
Millennium Pharmaceuticals, Inc.,Cambridge,United States
,
Katharina Verleger
Affiliations:
Pharmerit International,Berlin,Germany
,
Youngmin Kwon
Affiliations:
Pharmerit International,Bethesda,United States
,
Shelby Corman
Affiliations:
Pharmerit International,Bethesda,United States
,
Dasha Cherepanov
Affiliations:
Millennium Pharmaceuticals, Inc.,Cambridge,United States
,
M. Janelle Cambron-Mellott
Affiliations:
Kantar Health,New York,United States
,
Haris G. Vikis
Affiliations:
Kantar Health,New York,United States
,
Athanasios Zomas
Affiliations:
Takeda Pharmaceuticals International AG,Glattpark-Opfikon,Switzerland
,
Karthik Ramasamy
Affiliations:
Oxford University Hospitals,Oxford,United Kingdom
,
Francois Gavini
Affiliations:
Takeda Pharmaceuticals International AG,Glattpark-Opfikon,Switzerland
Wolfgang Knauf
Affiliations:
Center for Hematology and Oncology,Agaplesion Bethanien Hospital,Frankfurt am Main,Germany
EHA Library. Romanus D. Jun 15, 2019; 267033; PS1416
Dr. Dorothy Romanus
Dr. Dorothy Romanus
Contributions
Abstract

Abstract: PS1416

Type: Poster Presentation

Presentation during EHA24: On Saturday, June 15, 2019 from 17:30 - 19:00

Location: Poster area

Background

Multiple myeloma (MM) guidelines from the European Society of Medical Oncology (2013) recommend first-line (1L) therapy with either bortezomib (a proteasome inhibitor [PI]) or thalidomide (an immunomodulatory drug [IMID]), with melphalan (an alkylator [alk]) and prednisone for symptomatic patients who are SCT-ineligible. These guidelines were updated in 2017 and include now the lenalidomide (an IMID) plus dexamethasone option. As new PIs and IMIDs are introduced, changes in practice patterns are expected to occur.

Aims

To describe patient characteristics, cytogenetic risk, and treatment patterns in NDMM in France, Germany, and the UK diagnosed in 2012-2013 and 2016-2017.

Methods

Adult patients (≥18 years) with symptomatic NDMM who did not undergo a frontline SCT (nSCT) between January 1, 2012 and December 31, 2013 (Early Cohort) or between April 1, 2016 and March 31, 2017 (Recent Cohort) were sampled retrospectively from the same oncology/hematology practices in both periods. Medical chart data were extracted from diagnosis to most recent visit/death. First-line regimens were categorized as containing an IMID, PI, alk, or combinations of these drug classes. Pearson’s chi-square and Fisher’s tests were used to test for significant differences between countries and cohorts.

Results

A total of 700 patients (France: 269; Germany: 213; UK: 218; Early cohort: 497; Recent cohort: 203) were included in the study; median age at MM diagnosis in each country was 73-76 years and 55% were male. Charlson comorbidity index was 0 (28%), 1 (26%), or ≥2 (45%). The proportion of patients with cytogenetic testing performed was significantly different between countries (France: 42%; Germany: 13%; UK: 19%; P<0.001) and cohorts (Early: 26%; Recent: 37%; P<0.001). Across all countries, 74% of patients had an unknown cytogenetic risk, defined as no testing performed; 6% a high risk, defined as presence of del17p, t(4;14), and/or t(14;16); and 19% a standard risk, defined as ≥1 cytogenetic test performed without high risk. The most common 1L treatment plan followed a fixed duration of therapy (63%), followed by treatment to response (23%) and until progression (14%); between the 2 cohorts, the proportion treated for a fixed duration of therapy increased in Germany and decreased in France. Most patients received triplet or quadruplet therapy (France: 61%; Germany: 73%; UK: 73%). A combination containing a PI + alk was the most commonly prescribed 1L treatment overall (33%) with significant differences between countries (France: 39%; Germany: 42%, UK: 17%; P<0.001), followed by a combination containing an IMID + alk (26%; France: 13%; Germany: 17%; UK: 50%; P<0.001). The frequency of IMID + alk containing regimens decreased from 40% in the early cohort to 16% in the recent cohort, IMID-based combinations without alk increased from 8% to 17%, PI + IMID use increased from 3% to 8%, and use of alk-based regimens without PI or IMID decreased from 12% to 2% (P<0.001). Use of maintenance therapy was low in all countries (France: 5%; Germany: 1%, UK: 2%) across both periods.

Conclusion

The frequency of cytogenetic risk testing has significantly increased from 26% to 37% between nSCT  patients who were diagnosed with MM in 2012-2013 compared to 2016-2017. The use of alk-based treatments and IMID + alk combinations decreased in favor of PI + alk combinations and IMID-based regimens without alk. These data reflect the rapidly changing landscape of MM therapy. Further changes are expected with the recent approval of anti-CD38 antibodies in the elderly MM 1L setting.

Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical

Keyword(s): Multiple myeloma, Treatment

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