Real-world treatment patterns and associated progression-free survival in relapsed/refractory multiple myeloma among US community oncology practices

Background: Evidence supporting optimal treatment sequencing in relapsed/refractory multiple myeloma (RRMM) patients requiring multiple therapy lines is lacking. Methods: Using retrospective chart data, this study describes real-world RRMM treatment patterns and related progression-free survival (PFS) in US community oncology clinics. Results: Bortezomib ± a non-immunomodulatory drug (IMiD), lenalidomide ± a non-proteasome inhibitor (PI), bortezomib + an IMiD were the most commonly used regimens in early lines of therapy. Median PFS was similar in 1st (11.1 months) and 2nd line (10.5) and decreased in lines 3 through 5 (3rd: 7.9; 4th: 7.2, 5th: 5.4). Longest PFS (12.5 months) in first line was with bortezomib + ImiD; longest PFS in second line was with lenalidomide ± a non-PI was (13.2 months). Conclusions: Re-treatment with bortezomib was common; novel agents were reserved for later therapy lines. Overall, the observed PFS associated with real-world treatment sequences were shorter than those reported in clinical trials.

研究背景：目前尚缺乏针对需要多线治疗的复发难治性多发性骨髓瘤（relapsed/refractory multiple myeloma, RRMM）患者的最优治疗序贯方案相关证据。
研究方法：本研究利用回顾性病历数据，对美国社区肿瘤诊所中复发难治性多发性骨髓瘤患者的真实世界治疗模式及相关无进展生存期（progression-free survival, PFS）进行了描述。
研究结果：硼替佐米（Bortezomib）±非免疫调节药物（immunomodulatory drug, IMiD）、来那度胺（Lenalidomide）±非蛋白酶体抑制剂（proteasome inhibitor, PI）、硼替佐米（Bortezomib）+免疫调节药物（IMiD）是早期治疗线中最常用的治疗方案。一线治疗的中位无进展生存期（11.1个月）与二线治疗（10.5个月）相近，而三线至五线治疗的中位无进展生存期依次降低（三线：7.9个月；四线：7.2个月；五线：5.4个月）。一线治疗中，硼替佐米+免疫调节药物（IMiD）方案的中位无进展生存期最长，达12.5个月；二线治疗中，来那度胺±非蛋白酶体抑制剂（PI）方案的中位无进展生存期最长，为13.2个月。
研究结论：硼替佐米的再治疗应用较为普遍；新型药物多被留用于后续治疗线。总体而言，本研究观察到的真实世界治疗序贯方案对应的无进展生存期短于临床试验中报道的结果。