| Popis: |
Objectives: The treatment landscape for relapsed/refractory multiple myeloma (RRMM) has evolved over the last decade, and several therapeutic options are now available in Brazil. However, approval and access to new treatments may be delayed, potentially impacting patient (pt) outcomes. This study assessed real-world (RW) treatment patterns and outcomes in pts with RRMM to understand the current treatment landscape and unmet needs in Brazil. Material and methods: This retrospective, cross-sectional chart review included pts with RRMM who initiated a third-line (3L) MM-specific treatment regimen between 01-Jan-2015 and 31-Dec-2020 and had received at least two prior lines of therapies, including lenalidomide (LEN) and at least one proteasome inhibitor. Physicians (n = 50; mean practice duration: 11 months [m]; spent at least 60.0% of their time in pt care; practiced in the private sector: 56.0%; practiced in private and public sectors: 42.0%; practiced in the public sector: 2.0%) managing at least 10 MM pts for past 12 m contributed data from pt charts via a structured data collection form. The International Centralized Institutional Review Board approved the study. Data on demographics, clinical characteristics, treatment patterns and overall survival (OS) were collected and analyzed. Results: Of the included 100 pts (mean [SD] age at first RRMM diagnosis: 58.7 [14.3] years; male: 58.0%), most had moderate-to-good performance status based on Eastern Cooperative Oncology Group scores (Grade 1: 70.0%; Grade 2: 21.0%) and reported Stage 2 (38.9%) and Stage 3 (51.9%) disease based on the International Staging System. Anemia (60.0%) was reported as the most common MM-related comorbidity. Bortezomib (BOR) and LEN-based regimens were the most used first-line (1L) treatment options irrespective of stem-cell transplant (SCT) status (SCT induction: BOR+cyclophosphamide+dexamethasone [VCd, 33.3%], BOR [22.2%]; SCT maintenance: BOR [66.7%], LEN [11.1%], BOR+thalidomide [VT, 11.1%]; non-SCT: VCd [14.3%], BOR [9.9%], LEN [9.9%]). LEN-based regimens were commonly used in second-line (2L) pts (LEN+d [Rd, 32.3%], LEN [17.7%]), and daratumumab (DARA)- and carfilzomib (CARF)-based regimens (DARA [25.3%], DARA+BOR+d [DVd, 11.6%], CARF+d [Kd, 7.4%]) were commonly used in 3L pts. Among pts with private health insurance, 37.0% were LEN-refractory. Median (interquartile range [IQR]) duration of treatment for 1L (SCT induction), 2L and 3L were 5.0 (3.7–6.2), 11.0 (4.6–14.3) and 5.7 (3.0–10.0) m, respectively. After the initiation of 2L and 3L, 75.0% and 18.8% of pts, respectively, experienced disease progression. The majority of pts who initiated 3L (72.0%) were alive at the time of the study; among pts who had died after initiating 3L (25.0%; n /N =24/96), the median OS was 12.9 m. Discussion: Treatment patterns observed were consistent with previous RW studies, with significant use of BOR- and LEN-based regimens noted in 1L and 2L, whereas newer therapies (DARA- and CARF-based regimens) were utilized in 3L. The generalizability of study findings may be limited due to the small sample size. Conclusion: A high proportion of patients with lenalidomide refractoriness and short duration of treatment underscore the need for improved access to more effective treatments for patients with RRMM in Brazil. |
