Abstract

<h3>Context</h3> Real-world data on treatment patterns and outcomes in patients with RRMM resistant to multiple drug classes are limited. <h3>Objective</h3> To assess clinical treatment patterns and refractory status in patients with RRMM. <h3>Methods</h3> This longitudinal retrospective cohort study utilized the COTA de-identified real-world database derived from US electronic medical records of partnered healthcare providers from Q3 1988 through Q1 2020; 650 adults with active RRMM previously exposed to ≥1 proteasome inhibitor (PI) and 1 immunomodulatory drug (double-exposed) and who received ≥3 prior lines of therapy (LOTs) were identified. Patients were further categorized as refractory to a PI and an immunomodulatory drug (double-class refractory [DCR]; n=381) or additionally to an anti-CD38 monoclonal antibody (i.e., daratumumab; triple-class refractory [TCR]; n=173). Index LOT was the fourth (double-exposed) or new LOT after evidence of DCR or TCR status following ≥3 or ≥4 prior LOTs (DCR or TCR, respectively). Median follow-ups from index LOT initiation through end of data availability/death were 24 (double-exposed), 14 (DCR), and 8 (TCR) months. Assessments included therapies received before/during the index LOT, duration of treatment (DOT), and treatment discontinuation reasons. <h3>Results</h3> Patient characteristics included age ≥65 years (49% DCR; 53% TCR), International Staging System stage III (14%; 16%), and high-risk cytogenetics (56%; 66%); >62% had prior autologous stem cell transplantation. Patients had a median of 3 (DCR) and 6 (TCR) prior LOTs. Retreatment percentages among DCR patients were 60% (PI) and 69% (immunomodulatory drug); 30% were exposed to daratumumab. For TCR patients, retreatment percentages were 65% (PI), 60% (immunomodulatory drug), and 29% (daratumumab). Median DOTs were 3.3 (DCR) and 2.8 months (TCR). Patients discontinued index therapy most commonly due to disease progression (59% DCR; 60% TCR) or toxicity (23%; 24%). After index LOT, 70% DCR and 58% TCR patients continued to a subsequent LOT. <h3>Conclusions</h3> Treatment options are limited for US patients with heavily pretreated RRMM. DCR/TCR patients were frequently retreated with a PI, immunomodulatory drugs, or daratumumab (TCR patients) despite refractoriness to these agents. Many DCR/TCR patients stopped active MM treatment after discontinuing index treatment. <h3>Funding</h3> GlaxoSmithKline (212953).

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