Current Clinical Practice and Decision-Making in Multiple Myeloma Treatment in the United States of America: A Real-World Survey
Authors: Ribbands Amanda , Gorsh Boris , Bailey Abigail , Boytsov Natalie , Luke Emily , Lambert Annabel , Hogea Cosmina 
Published: November 2021

Abstract
Introduction: With each successive line of therapy (LOT), treatment choice for patients with multiple myeloma (MM) becomes increasingly complicated due to existing regimens and the lack of consensus on the standard of care for relapsed/refractory disease. There is a need for more real-world (RW) information on current MM treatments and clinical practices. More insight into the complexity of treatment choices for MM, increasing with each LOT, is also needed to better understand and inform patient treatment as their MM progresses. We aimed to examine current clinical practice and decision-making in the RW setting in MM.
Methods: Data were derived from the Adelphi MM Disease Specific Programme™, a point-in-time survey of hematologists and hemato-oncologists conducted in the United States of America between August 2020 and July 2021, collating descriptive information on MM treatment patterns and decision-making from first-line (1L) to fourth-line therapy and beyond (4L+). Physicians completed online patient record forms for their next 8 consulting patients who had a confirmed diagnosis of MM and were actively receiving 1L-4L+ treatment (ie, a quota of ≥2 patients on each LOT).
Results: A total of 63 physicians were included in the interim analysis, reporting patients who ever received, or are on at the time of data collection, a specific LOT. Data were provided for 259 patients with 1L treatment, 186 with second-line (2L), 120 with third-line (3L), 60 with 4L, and 2 with fifth-line treatment. Of the patients included in the study, 66% were male with a mean age of 67.7 years (standard deviation 8.16 years); 59% of patients used Medicare for their health insurance and 32% of patients had commercial insurance. The majority of patients received triplet regimens in each LOT (1L: 72%, 2L: 72%, 3L: 68%, 4L: 43%). The top 5 triplet regimens are shown in Table 1. Regimens including cluster of differentiation (CD)38-targeted treatments were used across all LOTs, with the most frequent use seen in earlier relapsed/refractory settings (1L: 8%, 2L: 45%, 3L: 26%, 4L: 19%). Retreatment with the same drug class occurred in 53% of patients treated with a proteasome inhibitor, 50% of patients treated with immunomodulatory drugs, and 4% of patients treated with CD38-targeted treatment. Disease progression/relapse was the most frequent reason for treatment cessation across all LOTs among patients who used either mono, doublet, triplet, or quad regimens (1L: n=92 [48%], 2L: n=72 [61%], 3L: n=37 [63%], 4L: n=2 [100%]).
For all LOTs, the leading factors influencing physicians' treatment choice were good clinical data regarding overall survival (OS) (1L: 59%, 2L: 65%, 3L: 52%, 4L: 48%) followed by better efficacy overall (1L: 48%, 2L: 53%, 3L: 45%, 4L: 41%). In 3L, high overall response rate was also important (24%). Good clinical data regarding OS was the most frequent factor influencing choice of triplet regimens at 1L, 2L, and 3L (56%, 62%, and 50%, respectively), whereas manageable side effects profile was the leading factor driving choice of triplet regimen at 4L+ (43%). Other factors that influenced treatment choice included long-term safety, transplant eligibility, and effective use of the treatment as part of a combination therapy.
Conclusion: We provide valuable RW data on current treatment patterns and decision-making in MM. Interim analyses revealed a trend for use of triplet therapies across all LOTs, high retreatment rate with the same drug class, and the importance of survival data and clinical efficacy as key factors influencing physician selection of treatment. Additional analyses will be conducted as physicians complete their patient reporting for the study to identify unmet needs and opportunities for new treatment strategies in MM.
Funding: GlaxoSmithKline (Study 209997).
Figure 1 Figure 1.

Disclosures
Ribbands: Adelphi Real World, paid employee: Current Employment. Gorsh: GlaxoSmithKline: Current Employment, Current equity holder in publicly-traded company. Boytsov: GlaxoSmithKline: Current Employment, Current equity holder in publicly-traded company. Luke: Adelphi Real World, paid employee: Current Employment. Lambert: Adelphi Real World, paid employee: Current Employment. Hogea: GlaxoSmithKline, paid employee: Current equity holder in publicly-traded company, Ended employment in the past 24 months.