PF648 TREATMENT PATTERNS FOR MULTIPLE MYELOMA PATIENTS: A RETROSPECTIVE COHORT STUDY IN U.S. ELECTRONIC MEDICAL RECORDS DATABASE 2012–2018
Authors: P. Hari, H. Divan, R. Miao, P. Lin, M. Sasane, E. Drea, D. Latremouille-Viau
Journal: HemaSphere (2019)

Background: Many patients (pts) with multiple myeloma (MM) develop relapsed/refractory (R/R) disease and go through successive treatment regimens. With new therapeutic options available in recent years, the treatment of MM has become more complex, resulting in heterogeneity in treatment patterns, especially in the R/R setting. Aims: This study describes the current treatment landscape of MM in the US. Methods: Data from adult pts with MM who received treatment between Q1 2012 and Q3 2018 in the OPTUM electronic medical records database were analyzed. Those receiving stem cell transplants were not included. Lines of therapy (LT) were identified using drug and/or procedure codes. Combination therapy during a specific LT was defined as any MM therapy record observed within 60 days of the first therapy. End of LT included treatment augmentation or switch (a new MM therapy started >60 days after the first therapy of a LT), discontinuation of all therapies in a LT for >90 consecutive days, or death. The start of a subsequent LT was defined as a MM therapy after the end of the previous LT (including re-starting the same combination therapy). From 1st (1L) to 3rd line (3L), overall survival (OS) rate with 95% confidence interval (CI), duration of LT (DoT), and treatment regimens were assessed. A subgroup analysis was planned to examine outcomes in patients <65 years. Results: 4378 MM pts with 1L (median age = 70 years at 1L; 53.1% male) were included. Over a median follow-up of 20.2 months (mo) from 1L (median 1L DoT = 4.4 mo), 1822 (42%) pts received a 2L (median 2L DoT = 4.7 mo) and 761 (42%) received a 3L treatment (median 3L DoT = 4.2 mo). For all pts, the most prominent treatment regimens were bortezomib/corticosteroids (Vd) in 1L, and lenalidomide/corticosteroids (Rd) in 2L and 3L. The 1- and 2-year OS rates were 87.8% [95% CI, 86.8–88.7] and 80.2% [95% CI, 79.0–81.4] from 1L initiation, 83.0% [95% CI, 81.3–84.8] and 76.1% [95% CI, 74.2–78.1] from 2L initiation, and 80.4% [95% CI, 77.6–83.2] and 72.0% [95% CI, 68.8–75.2] from 3L initiation, respectively. For pts aged <65 years, 1427 MM pts 1L (58.5% male) were included. Over a median follow-up of 22.2 mo from 1L (median 1L DoT = 4.4 mo) 635 pts (44%) received a 2L (median 2L DoT = 4.7 mo) and 270 (43%) received a 3L (median 3L DoT = 4.7 mo). The most prominent treatment regimens were Vd in 1L, and Rd in 2L and 3L. The 1- and 2-year OS rates were 91.9% [95% CI, 90.5–93.4] and 86.8% [95% CI, 85.0–88.5] from 1L initiation, 88.4% [95% CI, 85.8–91.0] and 84.0% [95% CI, 81.0–87.0] from 2L initiation, and 86.5% [95% CI, 82.2–90.8] and 79.1% [95% CI, 74.0–84.2] from 3L initiation, respectively.Summary/Conclusion: Conclusions: Bortezomib- or lenalidomide-based doublet regimens were the most commonly used frontline regimens with limited use of triplet induction in these non-transplant MM pts. Pts aged <65 years had similar treatment patterns, though triplets and newer agents such as carfilzomib, pomalidomide and ixazomib gain more usage in later LT.