Mayo Clinic, Jacksonville, FL 32224, USA.
Analysis Group, Inc., Boston, MA 02199, USA.
Curr Probl Cancer. 2024 Jun;50:101078. doi: 10.1016/j.currproblcancer.2024.101078. Epub 2024 Mar 27.
This retrospective longitudinal study compared the effectiveness of dexamethasone+lenalidomide (Rd)-based triplet regimens containing proteasome inhibitors (PIs) ixazomib (IRd), carfilzomib (KRd), and bortezomib (VRd) or monoclonal antibodies (MABs) elotuzumab (ERd) and daratumumab (DRd) in patients with relapsed/refractory multiple myeloma (RRMM)-including those with high cytogenetic risk-primarily treated at community oncology clinics in the United States.
Electronic health records of adult RRMM patients in a deidentified real-world database (01/01/2014-09/30/2020) who initiated IRd, KRd, VRd, ERd, or DRd in the second or later line of therapy (LOT) were analyzed. The index date was the date of initiation of each LOT and baseline was the 6-month pre-index period. Duration of therapy (DOT), time to next therapy (TTNT), progression-free survival (PFS), and overall survival (OS) were compared across regimens with multivariable Cox proportional hazards models.
Of the 1,185 patients contributing 1,332 LOTs, 985 had standard cytogenetic risk (median age, 71 years) and 180 had high risk (median age, 69 years). Compared with other regimens, DRd was associated with longer DOT overall (adjusted hazard ratio [95 % confidence interval]: 1.84 [1.42, 2.38] vs. KRd, 1.65 [1.20, 2.28] vs. ERd, 1.58 [1.23, 2.04] vs. IRd, and 1.54 [1.18, 2.00] vs. VRd), and longer TTNT and PFS. KRd was associated with shorter OS compared with DRd (1.45 [1.01, 2.08]) and VRd (1.32 [1.01, 1.73]). High-risk patients had similar outcomes with all triplet regimens.
Although DRd improved clinical outcomes overall, Rd-based triplet regimens containing a PI or MAB are similarly effective in high-risk RRMM.
本回顾性纵向研究比较了含蛋白酶体抑制剂（PI）伊沙佐米（IRd）、卡非佐米（KRd）和硼替佐米（VRd）或单克隆抗体（MAB）来那度胺（ERd）和达雷妥尤单抗（DRd）的地塞米松+来那度胺（Rd）为基础的三联方案在接受过美国社区肿瘤学诊所一线治疗的复发/难治性多发性骨髓瘤（RRMM）患者（包括具有高细胞遗传学风险的患者）中的有效性，包括那些接受过治疗的患者。
分析了 2014 年 1 月 1 日至 2020 年 9 月 30 日期间在一个匿名真实世界数据库中接受过 IRd、KRd、VRd、ERd 或 DRd 二线或以上治疗（LOT）的成年 RRMM 患者的电子健康记录。索引日期为每个 LOT 的起始日期，基线期为索引前 6 个月。采用多变量 Cox 比例风险模型比较不同方案的治疗持续时间（DOT）、至下一治疗时间（TTNT）、无进展生存期（PFS）和总生存期（OS）。
在纳入的 1185 名患者中，共有 1332 名患者接受了 LOT 治疗，其中 985 名患者具有标准细胞遗传学风险（中位年龄 71 岁），180 名患者具有高风险（中位年龄 69 岁）。与其他方案相比，DRd 总体上具有更长的 DOT（调整后的危险比[95%置信区间]：1.84[1.42，2.38] vs. KRd，1.65[1.20，2.28] vs. ERd，1.58[1.23，2.04] vs. IRd，1.54[1.18，2.00] vs. VRd），以及更长的 TTNT 和 PFS。与 DRd（1.45[1.01，2.08]）和 VRd（1.32[1.01，1.73]）相比，KRd 与较短的 OS 相关。高危患者在所有三联方案中均有相似的结果。
尽管 DRd 总体上改善了临床结局，但含有 PI 或 MAB 的 Rd 为基础的三联方案在高危 RRMM 中同样有效。
