Real-world outcomes and factors impacting treatment choice in relapsed and/or refractory multiple myeloma (RRMM): a comparison of VRd, KRd, and IRd

Ajai Chari, Paul G. Richardson, Dorothy Romanus, Meletios A. Dimopoulos, Pieter Sonneveld, Evangelos Terpos, Roman Hajek, Aditya Raju, Antonio Palumbo, Lauren E. Cain, Marlo Blazer, Hui Huang, Eileen Farrelly, Sikander Ailawadhi

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Lack of head-to-head trials highlights a need for comparative real-world evidence of proteasome inhibitors plus Rd. Methods: In this retrospective, US population-representative EHR study of RRMM patients initiating IRd, KRd, or VRd in line of therapy (LOT) ≥2 between 1/2014 and 9/30/2018, 664 patients were treated in LOT ≥2 with: IRd, n = 168; KRd, n = 208; VRd, n = 357. Median age was 71/65/71 years; 67%/70%/75% had a frailtymodified score of intermediate/frail; 20%/28%/13% had high cytogenetic risk in I-/K-/V-Rd groups. Risk of PI-triplet discontinuation was lower for I- vs. K-Rd (HR: 0.71) and I- vs. V-Rd (HR: 0.85); unadjusted, median TTNTs (months): 12.7/8.6/14.2 (LOT ≥2) and 16.8/9.5/14.6 (LOT 2–3) (I-/K-/V-Rd). Adjusted TTNT was comparable between I-/K-/V-Rd in LOT ≥2 with a TTNT benefit among intermediate/frail patients for I- (HR: 0.70; P=0.04) and V- (HR: 0.73; P<0.05) vs. K-Rd. I/K/V-Rd triplets were comparable in TTNT overall, but IRd and VRd were associated with longer TTNT in intermediate/frail patients than KRd. The results suggest a trial-efficacy/real-world-effectiveness gap, especially for KRd, underlining the limited generalizability of trial results where >50% of patients are excluded. Individualized treatment based on patient characteristics, such as frailty status, is especially pertinent in an elderly RRMM population.

Original languageEnglish (US)
Pages (from-to)421-433
Number of pages13
JournalExpert Review of Hematology
Volume13
Issue number4
DOIs
StatePublished - Apr 2 2020

Keywords

  • Bortezomib
  • carfilzomib
  • ixazomib
  • PI-triplet therapy
  • proteasome-inhibitor-triplet therapy
  • real world
  • relapsed refractory multiple myeloma
  • RRMM

ASJC Scopus subject areas

  • Hematology

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    Chari, A., Richardson, P. G., Romanus, D., Dimopoulos, M. A., Sonneveld, P., Terpos, E., Hajek, R., Raju, A., Palumbo, A., Cain, L. E., Blazer, M., Huang, H., Farrelly, E., & Ailawadhi, S. (2020). Real-world outcomes and factors impacting treatment choice in relapsed and/or refractory multiple myeloma (RRMM): a comparison of VRd, KRd, and IRd. Expert Review of Hematology, 13(4), 421-433. https://doi.org/10.1080/17474086.2020.1729734