Τίτλος:
Real-world outcomes and factors impacting treatment choice in relapsed and/or refractory multiple myeloma (RRMM): a comparison of VRd, KRd, and IRd
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Συγγραφείς:
Chari, A.
Richardson, P.G.
Romanus, D.
Dimopoulos, M.A.
Sonneveld, P.
Terpos, E.
Hajek, R.
Raju, A.
Palumbo, A.
Cain, L.E.
Blazer, M.
Huang, H.
Farrelly, E.
Ailawadhi, S.
Περιοδικό:
Expert Review of Hematology
Εκδότης:
Taylor and Francis Ltd.
Λέξεις-κλειδιά:
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
DOI:
10.1080/17474086.2020.1729734
