TY - JOUR
T1 - Real-world outcomes and factors impacting treatment choice in relapsed and/or refractory multiple myeloma (RRMM)
T2 - a comparison of VRd, KRd, and IRd
AU - Chari, Ajai
AU - Richardson, Paul G.
AU - Romanus, Dorothy
AU - Dimopoulos, Meletios A.
AU - Sonneveld, Pieter
AU - Terpos, Evangelos
AU - Hajek, Roman
AU - Raju, Aditya
AU - Palumbo, Antonio
AU - Cain, Lauren E.
AU - Blazer, Marlo
AU - Huang, Hui
AU - Farrelly, Eileen
AU - Ailawadhi, Sikander
N1 - Publisher Copyright:
© 2020, © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
PY - 2020/4/2
Y1 - 2020/4/2
N2 - 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.
AB - 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.
KW - Bortezomib
KW - PI-triplet therapy
KW - RRMM
KW - carfilzomib
KW - ixazomib
KW - proteasome-inhibitor-triplet therapy
KW - real world
KW - relapsed refractory multiple myeloma
UR - http://www.scopus.com/inward/record.url?scp=85081351800&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85081351800&partnerID=8YFLogxK
U2 - 10.1080/17474086.2020.1729734
DO - 10.1080/17474086.2020.1729734
M3 - Article
C2 - 32148109
AN - SCOPUS:85081351800
SN - 1747-4086
VL - 13
SP - 421
EP - 433
JO - Expert Review of Hematology
JF - Expert Review of Hematology
IS - 4
ER -