P15: EVOLUTION OF MULTIPLE MYELOMA TREATMENT PATTERNS FROM 2015 THROUGH 2019: REAL-WORLD EVIDENCE FROM A EUROPEAN DATABASE STUDY
Authors: A Oriol Rocafiguera, T H Steinmetz, A Brescianini, S Gonzalez-McQuire, N Eugene, A Abbasi, S Wetten, X Leleu
Journal: HemaSphere (2022)

Novel treatment options in multiple myeloma (MM) have resulted in a dynamic and heterogeneous treatment landscape. To describe real-world treatment patterns across five European countries from 2015–2019. Using the MM Oncology Advantage database (IQVIA Ltd), this retrospective observational study analyzed data on patients receiving an ongoing treatment in any line from July 2015 through December 2019. Triplets accounted for almost two-thirds of all first-line (1L) therapies overall and 51% of second-line (2L) regimens in 2019, but monotherapy/doublets were still mainly used in third line or later (3L+: 86% in 2015-2016; 62% in 2019) with a gradual increase of triplets during the period. In 2019, most common 1L therapies were bortezomib (V)-based regimen with no immunomodulatory drug (IMiD) (37%), lenalidomide (R)-based without proteasome inhibitor (PI) (22%), and V and thalidomide (V+T) based (19%) regimens. Since 2015-16, V-based without IMiD, and Chemo±T regimens have decreased, and R-based regimens have increased over time (Table). V-based without IMiD (DE 51%; UK 38%; ES 35%; FR 30%; IT 29%) and R-based only (FR 30%; DE 24%, IT 27%; ES 23%) were most common in all countries in 1L except in UK and IT where V+T was the most common (42% and 35%, respectively). For 2L in 2019, approximately half of patients were treated with a novel regimen and the remaining received mainly R-based only (34%) or V-based without IMiD (11%). From 2015 to 2019, use of V-based without IMiD and R-based only regimens nearly halved (Table). In 2019, R-based only was common in ES (50%) FR (41%) and IT (35%); daratumumab (D)+R was most common in DE (34%) and V-based without IMiD common in UK (27%). For 3L+ in 2019, nearly half of patients received a novel regimen. About a third of patients received a pomalidomide (P)-based regimen consistently in 2019 and other years. Since 2015-16, overall use of R-based only, V-based without IMiD, and Chemo±T regimens have decreased from 64% to 18% in 2019 (Table). In 2019, P-based regimens were commonly used across all countries (FR 54%; IT 31%; DE 28%; ES 20%) except the UK where R-based only (37%) and other R regimens (42%) were used in almost all patients. Since 2015, R use has increased three-fold in 1L accounting for 34% of regimens in 2019. Despite fluctuations in combinations, R use has remained constant at around 70% in 2L and around 35% in 3L+. Treatment sequence in 616 patients receiving 3L in 2019 was described using 7 treatment classes: IMiD, monoclonal antibody [mAb] only, mAb+IMiD, mAb+PI, PI without IMiD, PI+IMiD, and other. There were 86 different sequence permutations, with the top 10 sequences comprising 58% of patients. Focusing on prior/current IMiD use, 65% didn't receive an IMiD in 1L (no=400), 26% received T (nt=158) and 10% R (nR=58). Of patients without 1L IMiD (no=400), 81% received R in 2L, and 64% of them had another IMiD in 3L. Among 1L R patients (nR=58), 83% had no IMiD in 2L, of whom 56% received an IMiD in 3L (35% P; 21% R). Re-treatment with R occurred infrequently with 12% of all patients with re-treatment occurring at any time. In conclusion, the uptake of novel agents since 2017 and the increased use of triplets (including R-based in 1L) continue to drive a changing MM treatment landscape with decreasing use of older combinations and increasing options at all lines of therapy. Differences in access to novel treatments might have influenced further heterogeneity between countries.