Frontline treatment patterns and attrition rates by subsequent lines of therapy in patients with newly diagnosed multiple myeloma

Autor: Peter M. Voorhees, Jianming He, Sarah Cote, Ravi Potluri, Mary Slavcev, Annette Lam, Eric M Maiese, Maneesha Mehra, Sandhya Nair, Jon Ukropec, Rafael Fonseca, Saad Z. Usmani
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Male
0301 basic medicine
Cancer Research
medicine.medical_specialty
Patient Dropouts
Treatment duration
Line of therapy
Newly diagnosed
Transplantation
Autologous
Newly diagnosed multiple myeloma
lcsh:RC254-282
Dexamethasone
Bortezomib
03 medical and health sciences
0302 clinical medicine
Internal medicine
Antineoplastic Combined Chemotherapy Protocols
Genetics
medicine
Humans
Attrition
Lenalidomide
Multiple myeloma
Aged
Retrospective Studies
Aged
80 and over
business.industry
Hematopoietic Stem Cell Transplantation
Prognosis
medicine.disease
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Combined Modality Therapy
Survival Rate
030104 developmental biology
Autologous stem cell transplant
Oncology
Attrition rates
030220 oncology & carcinogenesis
Female
Multiple Myeloma
business
Follow-Up Studies
Research Article
medicine.drug
Zdroj: BMC Cancer, Vol 20, Iss 1, Pp 1-11 (2020)
BMC Cancer
ISSN: 1471-2407
DOI: 10.1186/s12885-020-07503-y
Popis: Background For patients with multiple myeloma (MM), each additional line of therapy (LOT) is associated with lower response rates, shorter treatment duration and treatment-free intervals, and increased rates of toxicities and comorbidities. Here, we examine frontline treatment patterns, and attrition rates by LOT among newly diagnosed MM (NDMM) patients in the United States who were eligible or ineligible for autologous stem cell transplant (ASCT). Methods Data were identified from three US patient-level databases collectively covering the period January 2000 to September 2018. Patients had an index diagnosis of MM on or after January 1, 2007, medical and prescription insurance coverage at diagnosis, a 1-year look-back period prior to the index diagnosis, no prior malignancies in the 1-year period before index diagnosis, and had received ≥1 LOT. Results Among patients who did not receive ASCT (non-transplant; n = 22,062), 12,557 (57%) received only 1 LOT and 9505 (43%) received > 1 LOT. Patients receiving only 1 LOT were significantly older, had higher mean Charlson Comorbidity Index (CCI) scores, and higher incidences of comorbidities. Among the 2763 patients receiving ASCT, 2184 received > 1 LOT, and 579 (21%) received only 1 LOT (ie, ASCT was the last treatment). 1682 (61%) patients received induction therapy as frontline treatment, of whom 187 (11%) also received consolidation therapy. The latter group was younger than those who received only induction therapy, had lower mean CCI scores, and comparable or lower incidences of selected comorbidities. The most common frontline therapy for non-transplant and transplant-eligible patients was bortezomib/dexamethasone and bortezomib/lenalidomide/dexamethasone, respectively. Attrition rates across all LOTs were high for non-transplant patients (range, 43–57%) and transplant patients (range, 21–37%). Treatment duration decreased by LOT for non-transplant patients and was consistent across LOTs for transplant patients. Conclusions In this analysis, a substantial proportion of patients with NDMM who received frontline therapy did not appear to receive a subsequent LOT. These high attrition rates underscore the need to use the most optimal treatment regimens upfront rather than reserving them for later LOTs in which the clinical benefit may decrease.
Databáze: OpenAIRE
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