Real-world outcomes and factors impacting treatment choice in relapsed and/or refractory multiple myeloma (RRMM): a comparison of VRd, KRd, and IRd.

Expert Review of Hematology
Ajai ChariSikander Ailawadhi

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 treatmen...Continue Reading

References

Nov 26, 2010·Bone Marrow Transplantation·G CookUNKNOWN British Society for Blood and Marrow Transplantation (BSBMT)
Feb 5, 2011·Blood·S Vincent RajkumarUNKNOWN International Myeloma Workshop Consensus Panel 1
Dec 9, 2014·The New England Journal of Medicine·A Keith StewartUNKNOWN ASPIRE Investigators
Jan 27, 2015·Clinical Lymphoma, Myeloma & Leukemia·Robert M RifkinBrian G M Durie
Apr 28, 2016·The New England Journal of Medicine·Philippe MoreauUNKNOWN TOURMALINE-MM1 Study Group
May 12, 2016·Annals of Hematology·Virginie RondeauXavier Troussard
Nov 11, 2018·Blood Cancer Journal·Paul G RichardsonKenneth C Anderson

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Citations

Aug 13, 2020·Cancers·Ada Hang-Heng WongWee-Joo Chng
Sep 12, 2020·Clinical Lymphoma, Myeloma & Leukemia·Sudhir MandaRobert M Rifkin
Mar 15, 2021·Clinical Lymphoma, Myeloma & Leukemia·Ioannis Ntanasis-StathopoulosMeletios A Dimopoulos

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