TY - JOUR
TI - Real-world outcomes and factors impacting treatment choice in relapsed and/or refractory multiple myeloma (RRMM): a comparison of VRd, KRd, and IRd
AU - Chari, A.
AU - Richardson, P.G.
AU - Romanus, D.
AU - Dimopoulos, M.A.
AU - Sonneveld, P.
AU - Terpos, E.
AU - Hajek, R.
AU - Raju, A.
AU - Palumbo, A.
AU - Cain, L.E.
AU - Blazer, M.
AU - Huang, H.
AU - Farrelly, E.
AU - Ailawadhi, S.
JO - Expert Review of Hematology
PY - 2020
VL - 13
TODO - 4
SP - 421-433
PB - Taylor and Francis Ltd.
SN - 1747-4086, 1747-4094
TODO - 10.1080/17474086.2020.1729734
TODO - 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
TODO - 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.
ER -