MM-451 Treatment Patterns Among Patients With Relapsed/Refractory Multiple Myeloma (RRMM) Receiving Second-and Third-Line Therapy in a Medicare Population

Abstract

Despite novel therapy development, multiple myeloma remains incurable as patients relapse or become refractory to treatment. Physicians are challenged to optimize strategy at relapse with available treatment options. As a disease primarily affecting the elderly population, it is important to investigate treatment patterns in the Medicare population. Describe treatment patterns in 2nd and 3rd line of therapy (LoT) in US Medicare patients with RRMM. This retrospective cohort study utilized Medicare Fee-for-Service claims data (2015-2019) for patients with RRMM. Treatment distributions were examined across the following cohorts: 2nd and 3rd LoT initiators, double-class exposed (DCE), and triple-class exposed (TCE; prior receipt of ≥3 classes). Cohort sizes were: 2nd LoT (n=3670); 3rd LoT (n=1576); DCE (n=2013); TCE (n=105). The mean±SD age of the overall cohort (n=3670) was 75±8 years, 49% male, and 36% presented a Charlson Comorbidity Index ≥4. At 2nd LoT, most common regimens were lenalidomide (L) + steroids (S), bortezomib (B)LS, and BS (24%, 14%, 13%); in the DCE subset: LS, BLS, and BS (27%, 12%, 11%); in the TCE subset: daratumumab (D)S, DLS, and BDS (31%, 20%, 20%). At 3rd LoT, most common regimens were: LS, BS, and DS (18%, 10%, 8%); in the DCE subset (n=1173): LS, BS, DS (19%, 10%, 8%); in the TCE subset (n=104): pomalidomide (P)DS, DLS, and PS (14%, 13%, 13%). The most common prior therapies for 2nd and 3rd LoT initiators were B or L at 80%/57% and L or B at 48%/40%. Patients who received L in 3rd LoT were largely treated with L or B (B; 46%) or received autologous hematopoietic stem-cell transplantation (ASCT; 46%) at 2nd LoT; for those who received L in 2nd LoT, most were treated with B, L, or ASCT in some combination in 1st LoT (99%). While the landscape for RRMM treatment includes multiple drug classes, there remains a need for novel treatment options, indicated by the re-use of classes across LoTs. Over the study period, retreatment with agents and combinations may have contributed to the high proportions of patients using L and B in 3rd LoT settings. GlaxoSmithKline (209838).