MM-079: Real-World Treatment Patterns and Outcomes of Triple-Exposed Multiple Myeloma (MM) Patients Treated in Community Oncology Practices in the US

Context Most patients with MM become refractory to proteasome inhibitors (PIs), immunomodulatory drugs, and anti-CD38 monoclonal antibodies; limited evidence indicates these patients have poor outcomes. A US retrospective study showed that 275 patients treated at 14 academic institutions with prior exposure to these 3 agents (triple-exposed) had median overall survival (OS) of 9.2 months. Objective To evaluate real-world treatment patterns and outcomes (duration of therapy and OS) of patients previously treated with a PI, immunomodulatory drug, and anti-CD38 in US community practices. Methods This retrospective observational study used the Integra Connect (IC) database, which includes electronic health data from structured and unstructured fields from 12 community practices on both US coasts. Included were adults with ≥2 ICD-9/ICD-10 codes for MM on ≥2 separate dates who received MM treatment from 2016–2019 with treatment history including triple exposure and who initiated a subsequent line of therapy (s-LOT) after becoming triple-exposed. Outcomes included s-LOT length duration (days from s-LOT start to last-day supply of s-LOT) and OS (time from s-LOT start through death or last office visit date). Results This analysis included 501 patients (median age, 64.9 years; 50% male; 50% with commercial insurance); 82.8% had ECOG 0 or 1 at diagnosis and received a median of 3 prior lines of therapy (LOTs) before initiating s-LOT. Exposures prior to s-LOT included bortezomib (91%), carfilzomib (81%), lenalidomide (94%), pomalidomide (82%), and daratumumab (100%). In s-LOT, 95% received treatment that included the same drug/drug class (bortezomib [30%], carfilzomib [48%], lenalidomide [31%], pomalidomide [47%], and daratumumab [31%]). Median s-LOT duration was 78 days, and median survival was 10.3 months from s-LOT initiation. Conclusions For triple-class-exposed patients, there is lacking consensus on the most efficacious approach to subsequent treatment. This study shows significant retreatment with previously used agents/classes among these patients with short therapy duration and poor survival. New strategies and agents targeting novel aspects of MM are needed for these patients. ©2021 American Society of Clinical Oncology, Inc. Reused with permission. This abstract was accepted and previously presented at the 2020 ASCO Annual Meeting. All rights reserved. Funding GlaxoSmithKline (213286).