@article{3104571,
    title = "Real-world outcomes and factors impacting treatment choice in relapsed and/or refractory multiple myeloma (RRMM): a comparison of VRd, KRd, and IRd",
    author = "Chari, A. and Richardson, P.G. and Romanus, D. and Dimopoulos, M.A. and Sonneveld, P. and Terpos, E. and Hajek, R. and Raju, A. and Palumbo, A. and Cain, L.E. and Blazer, M. and Huang, H. and Farrelly, E. and Ailawadhi, S.",
    journal = "Expert Review of Hematology",
    year = "2020",
    volume = "13",
    number = "4",
    pages = "421-433",
    publisher = "Taylor and Francis Ltd.",
    issn = "1747-4086, 1747-4094",
    doi = "10.1080/17474086.2020.1729734",
    keywords = "bortezomib;  carfilzomib;  dexamethasone;  ixazomib;  lenalidomide;  proteasome inhibitor;  antineoplastic agent, adult;  aged;  Article;  cancer combination chemotherapy;  cancer patient;  cancer recurrence;  Charlson Comorbidity Index;  cohort analysis;  comparative effectiveness;  comparative study;  controlled study;  drug efficacy;  electronic health record;  frailty;  groups by age;  human;  major clinical study;  multiple myeloma;  outcome assessment;  priority journal;  relapsed and refractory multiple myeloma;  relapsed and refractory multiple myeloma;  retrospective study;  treatment duration;  clinical trial;  disease free survival;  female;  male;  middle aged;  mortality;  multicenter study;  multiple myeloma;  risk factor;  survival rate, Aged;  Antineoplastic Combined Chemotherapy Protocols;  Disease-Free Survival;  Female;  Humans;  Male;  Middle Aged;  Multiple Myeloma;  Retrospective Studies;  Risk Factors;  Survival Rate",
    abstract = "Lack of head-to-head trials highlights a need for comparative real-world evidence of proteasome inhibitors plus Rd. Methods: In this retrospective, US population-representative EHR study of RRMM patients initiating IRd, KRd, or VRd in line of therapy (LOT) ≥2 between 1/2014 and 9/30/2018, 664 patients were treated in LOT ≥2 with: IRd, n = 168; KRd, n = 208; VRd, n = 357. Median age was 71/65/71 years; 67%/70%/75% had a frailtymodified score of intermediate/frail; 20%/28%/13% had high cytogenetic risk in I-/K-/V-Rd groups. Risk of PI-triplet discontinuation was lower for I- vs. K-Rd (HR: 0.71) and I- vs. V-Rd (HR: 0.85); unadjusted, median TTNTs (months): 12.7/8.6/14.2 (LOT ≥2) and 16.8/9.5/14.6 (LOT 2–3) (I-/K-/V-Rd). Adjusted TTNT was comparable between I-/K-/V-Rd in LOT ≥2 with a TTNT benefit among intermediate/frail patients for I- (HR: 0.70; P=0.04) and V- (HR: 0.73; P<0.05) vs. K-Rd. I/K/V-Rd triplets were comparable in TTNT overall, but IRd and VRd were associated with longer TTNT in intermediate/frail patients than KRd. The results suggest a trial-efficacy/real-world-effectiveness gap, especially for KRd, underlining the limited generalizability of trial results where >50% of patients are excluded. Individualized treatment based on patient characteristics, such as frailty status, is especially pertinent in an elderly RRMM population. © 2020, © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group."
}