Delea Thomas E, Ma Qiufei, Kroog Glenn S, Ge Wenzhen, Moynahan Aaron, Sabater Anaya Natalia, Rodriguez Lorenc Karen, Song Xue
Avalere Health, 116 Huntington Avenue, Suite 903, Boston, MA, 02116, USA.
Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA.
Oncol Ther. 2024 Sep;12(3):565-583. doi: 10.1007/s40487-024-00291-6. Epub 2024 Aug 4.
Treatment of multiple myeloma (MM) has been transformed by novel therapies, including CD38 monoclonal antibodies (mAbs), immunomodulatory drugs (IMiDs), and proteasome inhibitors (PIs), resulting in increasing numbers of patients who are triple-class exposed (TCE; exposed to ≥ 1 drug in each class). Many patients are penta-exposed (PE; ≥ 2 IMiDs, ≥ 2 PIs, and a CD38 mAb), some are triple-class refractory (TCR), and some are PE and TCR (PE-TCR). Data on real-world outcomes in elderly patients with MM across this spectrum of exposure are limited.
Data from the Medicare Chronic Conditions Warehouse Database from November 2006-December 2020 were used to examine cohorts of TCE, TCR, PE, and PE-TCR patients. Outcomes were assessed from the start of the index line of therapy (LOT), defined as the first LOT after becoming TCE or PE.
A total of 2830 TCE, 1371 TCR, 1121 PE, and 774 PE-TCR patients were identified. Pomalidomide was the most frequently used medication for the index LOT in all cohorts (32.6% [PE-TCR] to 43.3% [TCR]). The most frequently used regimens for the index LOT were pomalidomide plus daratumumab for TCE (17.2%) and PE (7.0%), pomalidomide plus carfilzomib for TCR (10.3%), and pomalidomide plus elotuzumab for PE-TCR (7.4%). Median time to discontinuation (TTD) ranged from 4.2 (PE-TCR) to 6.9 (TCE) months, and overall survival (OS) ranged from 13.0 (TCR) to 15.9 (PE) months. Healthcare resource utilization (HRU) was lowest for TCE and highest for PE-TCR patients. Mean monthly healthcare costs (HCC) ranged from $23,091 (TCE) to $24,412 (PE-TCR). MM medications represented 66.2% (PE-TCR) to 72.8% (TCE) of costs.
In this study across a spectrum of Medicare TCE patients, there was heterogeneity in treatment regimens, suggesting no standard of care. TTD and OS were short, and HRU and HCC were high. These results underscore the potential for new therapies in this population.
包括CD38单克隆抗体（mAb）、免疫调节药物（IMiD）和蛋白酶体抑制剂（PI）在内的新型疗法改变了多发性骨髓瘤（MM）的治疗方式，导致接受三类药物暴露（TCE；每类中至少暴露于1种药物）的患者数量不断增加。许多患者接受了五类药物暴露（PE；至少2种IMiD、至少2种PI和1种CD38 mAb），一些患者对三类药物难治（TCR），还有一些患者既接受了五类药物暴露又是三类药物难治（PE-TCR）。关于老年MM患者在这一系列暴露情况下的真实世界结局的数据有限。
使用2006年11月至2020年12月医疗保险慢性病仓库数据库中的数据，对TCE、TCR、PE和PE-TCR患者队列进行研究。从治疗索引线（LOT）开始评估结局，治疗索引线定义为成为TCE或PE后的第一个LOT。
共确定了2830例TCE患者、1371例TCR患者、1121例PE患者和774例PE-TCR患者。泊马度胺是所有队列中治疗索引LOT最常用的药物（32.6%[PE-TCR]至43.3%[TCR]）。治疗索引LOT最常用的方案是泊马度胺联合达雷妥尤单抗用于TCE（17.2%）和PE（7.0%），泊马度胺联合卡非佐米用于TCR（10.3%），泊马度胺联合埃罗妥珠单抗用于PE-TCR（7.4%）。中位停药时间（TTD）为4.2个月（PE-TCR）至6.9个月（TCE），总生存期（OS）为13.0个月（TCR）至15.9个月（PE）。医疗资源利用率（HRU）在TCE患者中最低，在PE-TCR患者中最高。平均每月医疗费用（HCC）为23,091美元（TCE）至24,412美元（PE-TCR）。MM药物占费用的66.2%（PE-TCR）至72.8%（TCE）。
在这项针对医疗保险TCE患者群体的研究中，治疗方案存在异质性，表明没有标准治疗方案。TTD和OS较短，HRU和HCC较高。这些结果强调了该人群新疗法的潜力。
