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CARFILZOMIB IN RELAPSED/REFRACTORY MULTIPLE MYELOMA PATIENTS: THE REAL-LIFE EXPERIENCE OF EMMY
Author(s): ,
C Hulin
Affiliations:
CHU Bordeaux,Bordeaux,France;CHU Bordeaux,Bordeaux,Frankreich;CHU Bordeaux,Bordeaux,Francia;CHU Bordeaux,Bordeaux,France;CHU Bordeaux,Bordeaux,Francia;CHU Bordeaux,Bordeaux,Frankrijk;CHU Bordeaux,Bordeaux,França;CHU Bordeaux,Bordeaux,Франция ;CHU Bordeaux,Bordeaux,Frankrike
,
M Macro
Affiliations:
CHU Caen,Caen,France;CHU Caen,Caen,Frankreich;CHU Caen,Caen,Francia;CHU Caen,Caen,France;CHU Caen,Caen,Francia;CHU Caen,Caen,Frankrijk;CHU Caen,Caen,França;CHU Caen,Caen,Франция ;CHU Caen,Caen,Frankrike
,
A. Perrot
Affiliations:
CHU de Toulouse, IUC T-O,Toulouse,France;CHU de Toulouse, IUC T-O,Toulouse,Frankreich;CHU de Toulouse, IUC T-O,Toulouse,Francia;CHU de Toulouse, IUC T-O,Toulouse,France;CHU de Toulouse, IUC T-O,Toulouse,Francia;CHU de Toulouse, IUC T-O,Toulouse,Frankrijk;CHU de Toulouse, IUC T-O,Toulouse,França;CHU de Toulouse, IUC T-O,Toulouse,Франция ;CHU de Toulouse, IUC T-O,Toulouse,Frankrike
,
B Royer
Affiliations:
bruno.royer@aphp.fr,paris,France;bruno.royer@aphp.fr,paris,Frankreich;bruno.royer@aphp.fr,paris,Francia;bruno.royer@aphp.fr,paris,France;bruno.royer@aphp.fr,paris,Francia;bruno.royer@aphp.fr,paris,Frankrijk;bruno.royer@aphp.fr,paris,França;bruno.royer@aphp.fr,paris,Франция ;bruno.royer@aphp.fr,paris,Frankrike
,
D. Caillot
Affiliations:
CHU Dijon,Dijon,France;CHU Dijon,Dijon,Frankreich;CHU Dijon,Dijon,Francia;CHU Dijon,Dijon,France;CHU Dijon,Dijon,Francia;CHU Dijon,Dijon,Frankrijk;CHU Dijon,Dijon,França;CHU Dijon,Dijon,Франция ;CHU Dijon,Dijon,Frankrike
,
K Belhadj
Affiliations:
Hôpital Henri Mondor,Creteil,France;Hôpital Henri Mondor,Creteil,Frankreich;Hôpital Henri Mondor,Creteil,Francia;Hôpital Henri Mondor,Creteil,France;Hôpital Henri Mondor,Creteil,Francia;Hôpital Henri Mondor,Creteil,Frankrijk;Hôpital Henri Mondor,Creteil,França;Hôpital Henri Mondor,Creteil,Франция ;Hôpital Henri Mondor,Creteil,Frankrike
,
L. Frenzel
Affiliations:
Hôpital Necker,paris,France;Hôpital Necker,paris,Frankreich;Hôpital Necker,paris,Francia;Hôpital Necker,paris,France;Hôpital Necker,paris,Francia;Hôpital Necker,paris,Frankrijk;Hôpital Necker,paris,França;Hôpital Necker,paris,Франция ;Hôpital Necker,paris,Frankrike
,
R. Benramdane
Affiliations:
CH Cergy Pontoise,Cergy Pontoise,France;CH Cergy Pontoise,Cergy Pontoise,Frankreich;CH Cergy Pontoise,Cergy Pontoise,Francia;CH Cergy Pontoise,Cergy Pontoise,France;CH Cergy Pontoise,Cergy Pontoise,Francia;CH Cergy Pontoise,Cergy Pontoise,Frankrijk;CH Cergy Pontoise,Cergy Pontoise,França;CH Cergy Pontoise,Cergy Pontoise,Франция ;CH Cergy Pontoise,Cergy Pontoise,Frankrike
,
H. Demarquette
Affiliations:
CH. Dunkerque,Dunkerque,France;CH. Dunkerque,Dunkerque,Frankreich;CH. Dunkerque,Dunkerque,Francia;CH. Dunkerque,Dunkerque,France;CH. Dunkerque,Dunkerque,Francia;CH. Dunkerque,Dunkerque,Frankrijk;CH. Dunkerque,Dunkerque,França;CH. Dunkerque,Dunkerque,Франция ;CH. Dunkerque,Dunkerque,Frankrike
,
B. Bareau
Affiliations:
CH Cesson Sévigné,Cesson Sévigné,France;CH Cesson Sévigné,Cesson Sévigné,Frankreich;CH Cesson Sévigné,Cesson Sévigné,Francia;CH Cesson Sévigné,Cesson Sévigné,France;CH Cesson Sévigné,Cesson Sévigné,Francia;CH Cesson Sévigné,Cesson Sévigné,Frankrijk;CH Cesson Sévigné,Cesson Sévigné,França;CH Cesson Sévigné,Cesson Sévigné,Франция ;CH Cesson Sévigné,Cesson Sévigné,Frankrike
,
.S. Darre
Affiliations:
CH. Arras,Arras,France;CH. Arras,Arras,Frankreich;CH. Arras,Arras,Francia;CH. Arras,Arras,France;CH. Arras,Arras,Francia;CH. Arras,Arras,Frankrijk;CH. Arras,Arras,França;CH. Arras,Arras,Франция ;CH. Arras,Arras,Frankrike
,
C Calmettes
Affiliations:
CH. Périgueux,Périgueux,France;CH. Périgueux,Périgueux,Frankreich;CH. Périgueux,Périgueux,Francia;CH. Périgueux,Périgueux,France;CH. Périgueux,Périgueux,Francia;CH. Périgueux,Périgueux,Frankrijk;CH. Périgueux,Périgueux,França;CH. Périgueux,Périgueux,Франция ;CH. Périgueux,Périgueux,Frankrike
,
R Le Calloch
Affiliations:
CH Cornouaille ,Quimper,France;CH Cornouaille ,Quimper,Frankreich;CH Cornouaille ,Quimper,Francia;CH Cornouaille ,Quimper,France;CH Cornouaille ,Quimper,Francia;CH Cornouaille ,Quimper,Frankrijk;CH Cornouaille ,Quimper,França;CH Cornouaille ,Quimper,Франция ;CH Cornouaille ,Quimper,Frankrike
,
M Bouketouche
Affiliations:
CH. St Quentin,St. Quentin,France;CH. St Quentin,St. Quentin,Frankreich;CH. St Quentin,St. Quentin,Francia;CH. St Quentin,St. Quentin,France;CH. St Quentin,St. Quentin,Francia;CH. St Quentin,St. Quentin,Frankrijk;CH. St Quentin,St. Quentin,França;CH. St Quentin,St. Quentin,Франция ;CH. St Quentin,St. Quentin,Frankrike
,
K Laribi
Affiliations:
CH. Le Mans,Le Mans,France;CH. Le Mans,Le Mans,Frankreich;CH. Le Mans,Le Mans,Francia;CH. Le Mans,Le Mans,France;CH. Le Mans,Le Mans,Francia;CH. Le Mans,Le Mans,Frankrijk;CH. Le Mans,Le Mans,França;CH. Le Mans,Le Mans,Франция ;CH. Le Mans,Le Mans,Frankrike
,
N. Texier
Affiliations:
kappa santé,paris,France;kappa santé,paris,Frankreich;kappa santé,paris,Francia;kappa santé,paris,France;kappa santé,paris,Francia;kappa santé,paris,Frankrijk;kappa santé,paris,França;kappa santé,paris,Франция ;kappa santé,paris,Frankrike
,
M. Willaime
Affiliations:
kappa santé,paris,France;kappa santé,paris,Frankreich;kappa santé,paris,Francia;kappa santé,paris,France;kappa santé,paris,Francia;kappa santé,paris,Frankrijk;kappa santé,paris,França;kappa santé,paris,Франция ;kappa santé,paris,Frankrike
,
c. Deal
Affiliations:
IFM,paris,France;IFM,paris,Frankreich;IFM,paris,Francia;IFM,paris,France;IFM,paris,Francia;IFM,paris,Frankrijk;IFM,paris,França;IFM,paris,Франция ;IFM,paris,Frankrike
,
P. Moreau
Affiliations:
CHU Nantes,Nantes,France;CHU Nantes,Nantes,Frankreich;CHU Nantes,Nantes,Francia;CHU Nantes,Nantes,France;CHU Nantes,Nantes,Francia;CHU Nantes,Nantes,Frankrijk;CHU Nantes,Nantes,França;CHU Nantes,Nantes,Франция ;CHU Nantes,Nantes,Frankrike
O. Decaux
Affiliations:
CHU Rennes,Rennes,France;CHU Rennes,Rennes,Frankreich;CHU Rennes,Rennes,Francia;CHU Rennes,Rennes,France;CHU Rennes,Rennes,Francia;CHU Rennes,Rennes,Frankrijk;CHU Rennes,Rennes,França;CHU Rennes,Rennes,Франция ;CHU Rennes,Rennes,Frankrike
(Abstract release date: 05/12/22) EHA Library. Hulin C. 06/10/22; 357815; P955
C Hulin
C Hulin
Contributions
Abstract
Presentation during EHA2022: All (e)Poster presentations will be made available as of Friday, June 10, 2022 (09:00 CEST) and will be accessible for on-demand viewing until Monday, August 15, 2022 on the Congress platform.

Abstract: P955

Type: Poster presentation

Session title: Myeloma and other monoclonal gammopathies - Clinical

Background

EMMY is a large-scale epidemiological study to assess the epidemiology and real-life management of multiple myeloma (MM). Proteasome inhibitors (PI), immunomodulators (IMID) and anti-CD38 (aCD38) provide broad solutions to treat patients. Following pivotal clinical trials, carfilzomib, a second-generation PI, is approved in relapsed/refractory (RR) MM. Its use in real-life setting can be assessed in EMMY.

Aims

To assess the use of carfilzomib in RRMM patients in real-life conditions.

Methods

EMMY is a descriptive, multicenter, national, non-interventional study conducted in 72 IFM (Intergroupe Francophone du Myélome, sponsor) sites in France. Any patient initiating treatment for MM over a 3-month annual observation period, is included, since 2017 This dynamic cohort has included approximately 900 patients each year (2765 patients included in 2019). Data are updated annually from hospital records. Patients receiving carfilzomib (K) for RRMM at inclusion or follow up were identified and classified by the regimens received. The median progression-free survival (mPFS), and median overall survival (mOS) were estimated per regimen and per treatment line.

Results

512 patients (18.5%) (median age 68.4 years (y), 20.5% ≥75y) received K for RRMM, 111 (21.7%) for a second (L2), 97 (18.9%) a third (L3) and 304 (59.4%) a fourth or more (L4+) line. K was used in a double regimen with dexamethasone (Kd) in 232 patients (45.3%) and in a triple regimen either with an IMID (K-IMID) in 198 (38.7%) patients or with other agents in 82 patients (16%) (K-aCD38 for 35 (6.8%), K-alkylant for 27 (5.3%) and K-venetoclax for 19 (3.7%) patients). 25.4% patients (62/244) were at high cytogenetic risk.

K-IMID was used in patients of 66,8y, with an ECOG ≥ 2 for 20.8%, and comorbidities (≥ 1) for 24.3% including 3% of cardiovascular diseases.  K-IMID was used in L2 (42.9%), L3 (21.7%) and L4+ (35.4%). 63.1% were priorly exposed to lenalidomide (len) of which 35,9% were refractory. K was combined with len in 144 (28,1%) and with pomalidomide (pom) in 54 (10,5%) patients. The use of K-pom increased over years: 14,4% in 2018, 28,2% in 2019, 73,9% in 2020. mPFS was overall 10.4 months (m) 95%CI [7.3; 14.7]; it was 23m 95%CI [14.7; -] in L2, 6.2m 95%CI [1.3; 12.2] in L3 and 7.1m 95%CI [4.6; 9.2] in L4+. mOS was not reached in L2, L3 or L4+.

Kd was used in patients of 70.1y, with an ECOG ≥ 2 for 31.3% and comorbidities for 29.3%. 93.5% were priorly exposed to len of which 66.4% were refractory. Kd was used in L2(6%), L3 (17.2%) and L4+ (76.8%). mPFS and mOS were 4.4m [3.7; 5.8] and 19.5m [13.7; 22.3] in L4+.

K-aCD38 was used in patients of 63.5y, with an ECOG ≥ 2 for 10%, and comorbidities (≥ 1) for 37.1%. 91.4% were priorly exposed to len including 45.7% len-refractory. K-aCD38 (33/35 with daratumumab) was used in L2 (31.4%), L3/L4 (35.7%) and L5+ (22.9%). mPFS and mOS (all lines included) were 6m [3.8; 15.1] and 21.3m [16.9; -].

K-alkylant (5/27 with bendamustine, 22/27 cyclophosphamide) and K-venetoclax were used in older patients (71.8y and 70.4y) and in L4 or L5 for >80% of them. More than 90% were pre-exposed to len including 65% of len-refractory patients.

K discontinuation was recorded for 63.4% of patients for progression in 44% and adverse event in 11.7% of them.

Conclusion

The EMMY study shows that carfilzomib is used in many combinations in extended real-life settings compared to pivotal clinical trials including older patients, largely-exposed to lenalidomide and at advanced disease. The use of lenalidomide in early stages has led to a shift in the management of RRMM patients with carfilzomib.

Keyword(s):

Presentation during EHA2022: All (e)Poster presentations will be made available as of Friday, June 10, 2022 (09:00 CEST) and will be accessible for on-demand viewing until Monday, August 15, 2022 on the Congress platform.

Abstract: P955

Type: Poster presentation

Session title: Myeloma and other monoclonal gammopathies - Clinical

Background

EMMY is a large-scale epidemiological study to assess the epidemiology and real-life management of multiple myeloma (MM). Proteasome inhibitors (PI), immunomodulators (IMID) and anti-CD38 (aCD38) provide broad solutions to treat patients. Following pivotal clinical trials, carfilzomib, a second-generation PI, is approved in relapsed/refractory (RR) MM. Its use in real-life setting can be assessed in EMMY.

Aims

To assess the use of carfilzomib in RRMM patients in real-life conditions.

Methods

EMMY is a descriptive, multicenter, national, non-interventional study conducted in 72 IFM (Intergroupe Francophone du Myélome, sponsor) sites in France. Any patient initiating treatment for MM over a 3-month annual observation period, is included, since 2017 This dynamic cohort has included approximately 900 patients each year (2765 patients included in 2019). Data are updated annually from hospital records. Patients receiving carfilzomib (K) for RRMM at inclusion or follow up were identified and classified by the regimens received. The median progression-free survival (mPFS), and median overall survival (mOS) were estimated per regimen and per treatment line.

Results

512 patients (18.5%) (median age 68.4 years (y), 20.5% ≥75y) received K for RRMM, 111 (21.7%) for a second (L2), 97 (18.9%) a third (L3) and 304 (59.4%) a fourth or more (L4+) line. K was used in a double regimen with dexamethasone (Kd) in 232 patients (45.3%) and in a triple regimen either with an IMID (K-IMID) in 198 (38.7%) patients or with other agents in 82 patients (16%) (K-aCD38 for 35 (6.8%), K-alkylant for 27 (5.3%) and K-venetoclax for 19 (3.7%) patients). 25.4% patients (62/244) were at high cytogenetic risk.

K-IMID was used in patients of 66,8y, with an ECOG ≥ 2 for 20.8%, and comorbidities (≥ 1) for 24.3% including 3% of cardiovascular diseases.  K-IMID was used in L2 (42.9%), L3 (21.7%) and L4+ (35.4%). 63.1% were priorly exposed to lenalidomide (len) of which 35,9% were refractory. K was combined with len in 144 (28,1%) and with pomalidomide (pom) in 54 (10,5%) patients. The use of K-pom increased over years: 14,4% in 2018, 28,2% in 2019, 73,9% in 2020. mPFS was overall 10.4 months (m) 95%CI [7.3; 14.7]; it was 23m 95%CI [14.7; -] in L2, 6.2m 95%CI [1.3; 12.2] in L3 and 7.1m 95%CI [4.6; 9.2] in L4+. mOS was not reached in L2, L3 or L4+.

Kd was used in patients of 70.1y, with an ECOG ≥ 2 for 31.3% and comorbidities for 29.3%. 93.5% were priorly exposed to len of which 66.4% were refractory. Kd was used in L2(6%), L3 (17.2%) and L4+ (76.8%). mPFS and mOS were 4.4m [3.7; 5.8] and 19.5m [13.7; 22.3] in L4+.

K-aCD38 was used in patients of 63.5y, with an ECOG ≥ 2 for 10%, and comorbidities (≥ 1) for 37.1%. 91.4% were priorly exposed to len including 45.7% len-refractory. K-aCD38 (33/35 with daratumumab) was used in L2 (31.4%), L3/L4 (35.7%) and L5+ (22.9%). mPFS and mOS (all lines included) were 6m [3.8; 15.1] and 21.3m [16.9; -].

K-alkylant (5/27 with bendamustine, 22/27 cyclophosphamide) and K-venetoclax were used in older patients (71.8y and 70.4y) and in L4 or L5 for >80% of them. More than 90% were pre-exposed to len including 65% of len-refractory patients.

K discontinuation was recorded for 63.4% of patients for progression in 44% and adverse event in 11.7% of them.

Conclusion

The EMMY study shows that carfilzomib is used in many combinations in extended real-life settings compared to pivotal clinical trials including older patients, largely-exposed to lenalidomide and at advanced disease. The use of lenalidomide in early stages has led to a shift in the management of RRMM patients with carfilzomib.

Keyword(s):

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