Clinical consensus on treatments for transplant-ineligible newly diagnosed multiple myeloma: double-blinded Delphi panel
Creators: name: Fonseca, Rafael
name: Rossi, Adriana
name: Medhekar, Rohan
name: Voelker, Jennifer
name: Homan, Trevor
name: Wilcock, Jessica
name: Karakusevic, Anna
name: Cochrane, James
name: Bridge, Daisy
name: Perry, Richard
name: Kaila, Shuchita
name: Davies, Faith E
Publisher: name: Taylor & Francis
Year: 2024
Subjects: subject: Medicine
subject: Genetics
subject: FOS: Biological sciences
subject: Pharmacology
subject: Biotechnology
subject: Immunology
subject: FOS: Clinical medicine
subject: Cancer
subject: Science Policy
subject: Hematology
subject: Infectious Diseases
subject: FOS: Health sciences

description: <b>Aim:</b> Obtain clinical consensus on factors impacting first-line prescribing for transplant-ineligible (TIE) patients with newly diagnosed multiple myeloma (NDMM). <b>Materials &amp; methods:</b> A double-blinded, modified Delphi panel was employed. USA-based hematologists/oncologists who treat TIE patients with NDMM were selected as expert panelists. <b>Results:</b> Consensus was reached that patient frailty, performance status, comorbidities, treatment efficacy, and adverse event profile affect first-line prescribing. All panelists agreed it is important to use the most efficacious treatment first; 88% of panelists considered daratumumab-containing regimens the most efficacious. Panelists agreed treatment should be continued until progression while benefits outweigh risk. <b>Conclusion:</b> Findings reinforce the importance of using the most efficacious regimen upfront for TIE NDMM, and nearly all panelists considered daratumumab-containing regimens the most efficacious treatment. The purpose of this study was to determine the latest clinician preferences and opinions on factors affecting initial treatment selection for people recently diagnosed with multiple myeloma and unable to receive a bone marrow transplant, and to understand challenges with current treatments used in clinical practice. A panel of doctors with an average of two decades of experience treating blood disorders and cancers were recruited as expert panelists. Experts discussed treatment options by completing two rounds of surveys on treatment and one round of discussion. All experts agreed that the most effective treatment should be used first. Most experts considered treatment containing the drug daratumumab to be the most effective. Experts agreed that treatment should be continued until the cancer worsens if the treatment offers more benefits than side effects. A modified Delphi panel was conducted to obtain clinical consensus from a panel of multiple myeloma experts on factors impacting first-line (1L) prescribing, challenges with existing therapies, optimal duration of therapy, and treatment decision-making for transplant-ineligible (TIE) newly diagnosed multiple myeloma (NDMM). Consensus was reached that patient frailty, Eastern Cooperative Oncology Group performance status, and comorbidities, in addition to the treatment's effect on progression-free survival, overall survival, and adverse event profile, have a strong impact on treatment selection of 1L treatment for TIE NDMM. Panelists agreed that the most efficacious 1L therapy for TIE NDMM is the one that best improves overall survival, progression-free survival, and time to next treatment. All panelists agreed it is important to use the most efficacious treatment first, and 88% of panelists who selected a regimen considered daratumumab-containing regimens to be most efficacious. Of the two preferred regimens recommended by National Comprehensive Cancer Network Guidelines (bortezomib, lenalidomide, and dexamethasone; or daratumumab, lenalidomide, and dexamethasone [DRd]), a number of panelists responded that they preferred DRd as their choice of 1L therapy. Panelists considered neuropathy to be the greatest challenge when treating TIE patients with NDMM using bortezomib, which is consistent with its toxicity profile. Panelists agreed treatment should be continued until progression while the benefits outweigh the risks. These data may aid physician decision-making in the absence of head-to-head clinical trials among current 1L regimens for TIE patients with NDMM.