Treatment patterns in multiple myeloma: Real-world experience of the triple-class exposed (TCE) patient.

Abstract

e20543 Background: Recent advances in medical treatments have improved survival in multiple myeloma (MM), but relapse is a near certainty. TCE MM patients, i.e. treated with a proteasome inhibitor (PI), an immunomodulatory agent (IMiD), and anti-CD38, have been shown to have improved outcomes compared to patients with prior regimens, but patients who subsequently relapse have limited options. Objective: To describe the course of treatment in a real-world, TCE sample of patients with MM with an emphasis on treatments occurring after triple-exposure. Methods: This retrospective descriptive study used 100% Medicare Fee-for-Service claims data and Inovalon’s MORE² Registry, a commercial multi-payor claims database, to identify patients ≥ 18 years of age, newly diagnosed with MM in 2009-2017, and with ≥ 12 months continuous enrollment post-diagnosis. Patients with ≥ 3 lines of treatment (LOT) were considered relapsed/refractory MM (RRMM), and the TCE subset of those were analyzed in terms of number and timing of LOT. Results: 9534 patients were identified with RRMM and 29.2% (N = 2787) were TCE. TCE patients had a mean age of 70.8 and 50.1% were male. Treatment characteristics are shown in Table. Median number of LOT prior to TCE was 3, median time from diagnosis to TCE was 37 months, and 27.3% had a stem-cell transplant (SCT) prior to TCE. Patients had a median of 10 months of follow-up (range: 0-35) from end of the TCE LOT to end of follow-up. Nearly half (N = 1290, 46.3%) of the patients had at least 1 LOT post TCE, and 8% had at least 3. Over their entire post-TCE course of treatment, 826 (64%) received daratumumab, 443 (34%) received carfilzomib, and 356 (28%) received pomalidomide. 35.5% proceeded to penta-exposure (2 different PIs, 2 different IMiDs and an anti-CD38). Conclusions: While triple-exposure drug regimens have demonstrated improved outcomes, nearly half of the patients in this study received additional treatments beyond TCE and over 1/3 progressed to penta-exposure. Given the findings of this study, fundamentally new approaches are needed to close the gap and unmet medical need. [Table: see text]