| Popis: |
Objectives: The treatment landscape for relapsed/refractory multiple myeloma (RRMM) has witnessed a paradigm shift 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 of 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 second-line (2L) or third-line (3L) MM-specific treatment regimen between 01-Jan-2015 and 31-Dec-2020. 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 previous 12 m contributed data from pt charts via a structured data collection form. The International Centralized Institutional Review Board approved this study. Data on demographics, clinical characteristics, treatment patterns, and overall survival (OS) were collected and analyzed. Results: Of the included 133 pts (mean [SD] age at first RRMM diagnosis: 64.3 [10.1] years; male: 58.7%), most had moderate-to-good performance status based on Eastern Cooperative Oncology Group scores (Grade 1: 57.9%; Grade 2: 26.3%); reported Stage 2 (40.0%) and Stage 3 (45.9%) disease based on the International Staging System and low comorbidity burden (Charlson Comorbidity Index: mean [SD]: 2.8 [1.4]). Anemia (79.0%) and bone lesions (60.9%) were the most common reported symptoms, followed by hypercalcemia (42.9%) and renal failure (33.8%). Nearly one-third of pts (n /N =30/100; 30.0%) reported high-risk cytogenic status. Bortezomib (BOR) and lenalidomide (LEN)-based regimens were the most used first-line (1L) therapy in non-stem cell transplant (SCT) pts (BOR+cyclophosphamide+dexamethasone [VCd, 25.0%], LEN [R, 18.8%], V+thalidomide+d [VTd, 8.8%]) and as 1L induction therapy (VCd [32.1%], VRd [15.1%], VTd [9.4%]) in SCT pts. LEN and thalidomide-based regimens (37.7% each) were used as maintenance therapy in 1L. Daratumumab (DARA)- and carfilzomib (CARF)-based regimens were most utilized in 2L (DARA+R+d [DRd, 20.9%], CARF+R+d [KRd, 18.6%], DVd [13.2%]) and in 3L (DRd [19.7%], KRd [18.4%], Kd/LEN [7.9% each]). Among pts with private health insurance, 18.8% were LEN-refractory. Median (interquartile range [IQR]) duration of treatment for 1L (SCT induction), 2L, and 3L were 4.6 (3.2–5.8), 7.3 (5.0–16.0) and 8.0 (3.0–13.0) m, respectively. Nearly 60.0% of pts initiating 2L experienced disease progression. Majority of pts (65.1%) were alive at the time of study. Among pts who had died (̃35%; n =45), the median OS since 2L initiation was 20.5 m. Discussion: Treatment patterns observed were consistent with previous RW studies, with significant use of BOR- and LEN-based regimens noted in 1L and newer therapies in 2L and 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 underscores the unmet need for improved access to more effective treatment options for pts with RRMM in Brazil. |
