Patient Characteristics and Outcomes of Relapsed/Refractory Multiple Myeloma in Patients Treated with Proteasome Inhibitors in Germany

Abstract

Introduction: Real-world data reflects treatments and outcomes in clinical practice in contrast with controlled clinical trials. This study evaluates real-life multiple myeloma (MM) patients receiving proteasome inhibitor (PI)-based treatments in the second or third therapy line in 2017 in Germany. Methods: This is a retrospective chart review on adult relapsed/refractory MM patients treated with ≥1 dose of a PIbased regimen in either the second or the third line of therapy. Participating physicians had ≥3 years of clinical experience in treating symptomatic MM patients and used PI according to the label. Results: Distinct patient profiles for each PI-based regimen emerged. Younger, fitter, transplanteligible patients received novel PI triplets such as carfilzomib in combination with lenalidomide and dexamethasone (KRd) or IRd. Patients receiving lenalidomide in first-line therapy mostly received lenalidomide-free regimens in secondline therapy. In high-risk patients, no clear treatment patterns could be ascertained. The complete response rates were highest with KRd (13.0%), followed by carfilzomib in combination with dexamethasone (Kd) (5.7%) and bortezomib (4.8%). The very good partial response rates were highest with IRd (76.9%), followed by KRd (53.7%), Kd (25.7%), and bortezomib (20.5%). None of the KRd-or IRd-treated patients responded below a partial response. Discussion/Conclusion: Clear patient profiles for each PI type were observed. In second-line therapy, younger, fitter, transplant-eligible patients received novel-PI-based triplets, e.g., KRd or IRd. Patients treated with lenalidomide in first-line therapy mostly received lenalidomide-sparing regimens in second-line therapy. In high-risk patients no clear treatment patterns could be ascertained due to the limited sample size.

Management of Patients with Relapsed and/or Refractory Multiple Myeloma Treated with Novel Combination Therapies in Routine Clinical Practice in Germany

“…In addition, approximately one-third of patients (30%) had hypercalcemia, and around one-quarter of patients (24%) had renal dysfunction at diagnosis. All of these symptoms were slightly higher than our previous study [12] but similar to other reports [16,22,28,29] and highlight their value in aiding decisions on the treatment of patients who are at high risk of disease progression and who would benefit from therapy [30].…”

“…Overall, 30% of patients of all lines of therapy had at least one ASCT, and most patients received ASCT before second line, comparable to that reported by Raab et al (31%) [21]. In the analysis of second-line treatment regimens in the present study, substantially more patients with prior transplantation were likely to receive daratumumab-based regimens (mainly DRd) than carfilzomib-based regimens and this differs from a previous study where KRd was the most common regimen in previously transplanted German patients [12]. In second-line transplant-ineligible patients, DRd use was approximately half that seen in transplant-eligible patients and KRd use was very similar irrespective of patient transplant status.…”

“…It was planned that each physician collects, on average, approximately 80% second-and third-line data and 20% fourth-or later-line data. The sample size was not powered for treatment comparisons and this study aimed to provide a purely descriptive review of the clinical practice and outcomes of patients, based on the inclusion criteria and experience from previous studies in multiple myeloma in Germany [12,16]. Physicians documented patients who received either second-or third-line multiple myeloma treatment between October 1, 2017 and June 30, 2018, and patients who received fourth-or later-line treatment between May 1, 2017 and June 30, 2018.…”

Effectiveness of Long-Term Treatment of Multiple Myeloma in Regular Care: Comparison of a Longitudinal and a Cross-Sectional Analysis Approach

“…due to regional availability and/or reimbursement of new treatments. As the state of the art has changed over a period of 8 years, this may be less easily evaluated than in a cross-sectional study; however, by and large, our practice, including the rate of high-dose chemotherapy and stem cell transfusion, appeared to be in line with previous reports on treatment in regular care [4, 7, 8, 10, 12, 14, 16]. The relatively large frequency of HD-MEL + aSCT of 48% in the 2016–2019 period may be due to the younger age of patients during this period (Table 1).…”

“…As a consequence, there is a topical interest in real-world data, and quite some large cross-sectional studies in a regular care setting across countries have been reported [4, 7-16], using chart reviews over rather limited periods of time. Among these is a pivotal study performed in 2014, which reported alerting decreases in (a) the percentage of patients reaching consecutive treatment lines and (b) the effectiveness and length of consecutive treatment lines, across Western Europe [8, 9].…”