P24: EXPERT PERSPECTIVES OF UNMET NEED IN PATIENTS WITH RELAPSED/REFRACTORY MULTIPLE MYELOMA (RRMM) WHO RECEIVE LENALIDOMIDE-SPARING REGIMENS IN EUROPE
Authors: M Mateos, X Leleu, E Zamagni, M Delforge, S Bringhen, A Broijl, J de la Rubia, A Shaw, A Brescianini, S Gonzalez-McQuire, S Patel, P Moreau
Journal: HemaSphere (2022)

Background: First-line usage of lenalidomide (LEN) is prevalent and is increasing with the availability of lower cost generic LEN but also leads to resistance to therapies in later lines as patients become LEN-refractory. LEN-sparing regimens available and utilised at the time of this study in October 2020, predominantly doublet regimens and the triplet combination therapy of daratumumab (D) with bortezomib (V) plus dexamethasone (d), DVd, had limited efficacy compared with LEN-based regimens. This raises the need for highly effective LEN-sparing regimens to treat relapsed/refractory multiple myeloma (RRMM). Objective: To understand the unmet need of RRMM patients as perceived by physicians with the goal of providing insights and reaching consensus relating to patients receiving LEN-sparing regimens in RRMM. Methods: To capture physician perspectives of unmet need and treatment patterns in RRMM across Europe, a web-based, double-blind observational survey was designed and completed by physicians who treated ≥20 patients with RRMM in the preceding 3 months to September 2020. The output of this physician survey was discussed by a panel of 8 European experts (who are authors) via an abbreviated virtual Delphi panel process in October 2020. Results: In total, 51 physicians across Belgium, France, Italy, The Netherlands and Spain completed the survey. Forty-seven percent and 63% of their patients with RRMM were reported to be LEN-refractory in the second- and third-line settings, respectively. According to the physicians’ experience, patients receiving LEN-sparing regimens available at the time of the study experienced poorer clinical outcomes than those who received LEN-based regimens in terms of overall survival, progression-free survival, response rate, and duration of treatment. There were minimal perceived differences in real-world effectiveness amongst the LEN-sparing regimens at the time of the survey/panel including Vd, DVd, pomalidomide (Pom)d, and carfilzomib (K)d. The survey results indicated no clear differences in patient characteristics between RRMM patients treated with LEN-based or LEN-sparing regimens (Table). Treatment choices appeared to be patient-specific; there were no clear relationships between prior treatments or comorbidities driving the choice of LEN-sparing regimens. Over half of survey physicians (53%) reported their dissatisfaction regarding the typical LEN-sparing regimens utilised at the time of the survey and a greater proportion (75%) perceived the need for more LEN-sparing combinations. Collectively, experts strongly agreed with the physician survey findings and noted that LEN-refractory patients universally experience poor outcomes with the LEN-sparing regimens available at the time of this survey. Approximately 90% of patients requiring a LEN-sparing regimen are those becoming refractory to LEN used as maintenance or continuous therapy, and LEN-refractory patients are particularly difficult to treat. Therefore, high use of LEN in early treatment lines drives the difficulty to treat in subsequent lines. Conclusion: Since October 2020, the RRMM treatment landscape has evolved rapidly with the availability of novel anti-CD38-containing regimens such as KdD, Isatuximab (Isa)Kd and DPomd which have the potential to overcome this need. The development of novel LEN-sparing treatment options is still a relevant and important treatment innovation in RRMM given the use of LEN-based regimens in frontline persists.