Real-world data confirm that there is no standard approach for treating patients with triple-class-exposed relapsed/refractory multiple myeloma (RRMM), and these patients continue to have poor outcomes. 

Researchers found high variability in treatment regimens for triple-exposed RRMM patients. In addition, these patients had poor overall survival (OS) and progression-free survival (PFS).

These findings were presented at the Tandem Meetings 2022 by Michel Delforge, MD, PhD, of Universitaire Ziekenhuizen Leuven in Belgium.


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Dr Delforge pointed out that outcomes are dismal for RRMM patients who have failed treatment with immunomodulatory agents (IMiDs), proteasome inhibitors (PIs), and anti-CD38 monoclonal antibodies (mAbs). There is no standard care for these heavily pretreated patients, and there remains an incomplete understanding of patient management practices and real-world outcomes in this population, he added.

To gain some insight, Dr Delforge and colleagues conducted a retrospective chart review of patients with triple-class exposed and triple-line exposed RRMM. The patients were treated at 7 centers in Belgium.

The study included 112 patients who had received 3 or more prior lines of therapy, including at least 1 IMiD, PI, and anti-CD38 mAb. In all, patients had received 237 lines of treatment. Of these treatment lines, 62% were given to patients who had 5 or more prior lines of therapy, and 48% were given to patients whose time to progression on their last therapy was less than 4 months. 

After triple-class exposure, patients received more than 50 unique treatment regimens. The most common were carfilzomib plus dexamethasone (14%), pomalidomide plus cyclophosphamide and dexamethasone/prednisone (11%), ixazomib plus lenalidomide and dexamethasone (6%), and pomalidomide plus bortezomib and dexamethasone (6%). Nine percent of patients were enrolled on a clinical trial or compassionate use/medical need program.

The most frequently used treatment classes after triple exposure were PI only (19%), PI plus IMiD (17%), and regimens including anti-CD38 mAbs (15%). Four percent of patients received anti-BCMA agents. 

The median follow-up was 16.6 months. The overall response rate for the entire cohort was 27.4%, with 11.0% of patients achieving a very good partial response or better.

The median OS was 9.8 months, the median PFS was 3.4 months, and the median time to next treatment was 3.6 months.  

Prognostic markers associated with worse PFS and OS were higher refractory status, male sex, older age, shorter duration of treatment in prior lines of therapy, shorter time to progression in prior lines, and higher lactate dehydrogenase levels.

Dr Delforge noted that outcomes in this patient cohort were similar to outcomes observed in other countries across Europe, Asia, and North America, according to the medical literature.

“This retrospective chart review of patients with triple-class-exposed relapsed/refractory multiple myeloma in Belgium shows a wide variety of treatment regimens that are used in daily clinical practice, both in academic and community hospitals,” Dr Delforge said. 

“Our data confirm the absence of a clear standard of care in this patient population with a high unmet medical need. Several studies are ongoing in many parts of the world to better pinpoint the unmet medical need in patients with relapsed/refractory multiple myeloma.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Delforge M, Vekemans MC, Anguille S, et al. Treatments in patients with relapsed/refractory multiple myeloma (RRMM): Real-world outcomes for standard of care (SOC). Tandem Meetings 2022; April 23-26, 2022. Abstract 7. 

This article originally appeared on Cancer Therapy Advisor