Poster: MM-079: Real-World Treatment Patterns and Outcomes of Triple-Exposed Multiple Myeloma (MM) Patients Treated in Community Oncology Practices in the US

e18727 Background: Treatment for multiple myeloma (MM) over the past decade has significantly improved survival. In particular, 3 drug classes have altered the treatment paradigm for MM patients: proteasome inhibitors (PIs), immunomodulatory drugs (IMiDs), and CD38 monoclonal antibodies (anti-CD38s). Despite these advances, the majority of patients with MM will become refractory to PIs, IMiDs, and anti-CD38s, and limited evidence indicates these patients have poor outcomes. A retrospective study in the US showed that 275 patients treated at 14 academic institutions with prior exposure to a PI, IMiD, and anti-CD38 had median overall survival of 9.2 months. The aim of this study was to evaluate real-world treatment patterns and outcomes (duration of therapy and overall survival) of patients who had been treated with a PI, IMiD, and anti-CD38 in community practices in the US. Methods: This retrospective observational study was conducted using the Integra Connect (IC) database. The IC database includes electronic health data from structured and unstructured fields from 12 community practices on the East and West Coast of the US. Adult patients with ≥2 ICD-9/ICD-10 codes for MM on at least 2 separate dates, who received MM treatment between Jan 1, 2016, and Dec 31, 2019, with treatment history that included at least one PI, one IMiD, and one anti-CD38 (triple exposed), and initiated a subsequent line of therapy (s-LOT) after becoming triple exposed, were included. Duration of length of s-LOT was defined as number of days from start of s-LOT to last-day supply of s-LOT. Overall survival was defined as the length of time from start of s-LOT through death or the date of the last office visit. Results: A total of 501 patients were included in this analysis. The median age of patients was 64.9 years; 50% were male; 50% had commercial insurance. 82.8% of patients had ECOG 0 or 1 at diagnosis and had received a median of 3 prior lines of therapy (LOTs) before initiating s-LOT. Prior to initiating s-LOT, 91% had been exposed to bortezomib, 81% to carfilzomib, 94% to lenalidomide, 82% to pomalidomide, and 100% to daratumumab. In s-LOT, 95% received treatment that included same drug or same drug class (30% received bortezomib, 48% carfilzomib, 31% lenalidomide, 47% pomalidomide, and 31% daratumumab). The median duration of s-LOT was 78 days and median survival was 10.3 months (308 days) from initiation of s-LOT. Conclusions: For triple-class exposed patients, there is a lack of consensus on the most efficacious approach to subsequent treatment. The present study shows a significant amount of retreatment with previously used agents or classes among these patients with short duration of therapy and poor survival. As has been previously noted, new strategies and agents targeting novel aspects of MM are needed to improve outcomes for these patients. Disclosures: This study (213286) was sponsored by GlaxoSmithKline.

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Daratumumab utilization and cost analysis among patients with multiple myeloma in a US community oncology setting

Future Oncology ◽

10.2217/fon-2021-1072 ◽

2021 ◽

Author(s):

Lucio N Gordan ◽

Stanley M Marks ◽

Mei Xue ◽

Neil Nagovski ◽

J Hunter Lambert ◽

...

Keyword(s):

Multiple Myeloma ◽

Treatment Patterns ◽

Cost Of Care ◽

Dosing Schedule ◽

Community Oncology ◽

Improved Outcomes ◽

The Us ◽

Us Fda ◽

The Cost ◽

The Impact

Background: The introduction of daratumumab into the treatment of multiple myeloma has improved outcomes in patients; however, community oncologists often dose more frequently than the US FDA-approved label. Materials and methods: Integra analyzed its database to elucidate daratumumab treatment patterns and the impact of increased utilization on the cost of care for multiple myeloma. Results: Following week 24, 671 (65%) of 1037 patients remained on daratumumab-containing regimens, with 330 patients continuing more frequent treatments than the expected once-every-4-weeks dosing described in the standard dosing schedule. Patients received an average of 14% more daratumumab doses than the FDA-approved label indicates, increasing the 1-year daratumumab costs by an estimated US$31,353. Conclusion: Daratumumab is utilized more frequently than the FDA-recommended dosing, leading to higher multiple myeloma treatment costs.

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Characteristics of adult multiple myeloma patients receiving carfilzomib in a U.S. community oncology setting.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e19517 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e19517-e19517

Author(s):

Robert M. Rifkin ◽

Rohan Medhekar ◽

Khalid Mezzi ◽

Kathleen Aguilar ◽

Thomas Wilson ◽

...

Keyword(s):

Clinical Trial ◽

Multiple Myeloma ◽

Real World ◽

Older Patients ◽

Patient Characteristics ◽

Refractory Multiple Myeloma ◽

Female Patients ◽

Community Oncology ◽

The Us ◽

Baseline Characteristics

e19517 Background: Carfilzomib (K) is indicated for treatment of relapsed or refractory multiple myeloma (MM). We studied the characteristics of patients receiving K in the US Oncology Network’s (USON) EHR database. Methods: Patients ≥18 years who received a K-containing regimen between 11/01/2013-02/29/2016, were not in a clinical trial, and had ≥2 visits at a USON clinic were eligible. Baseline characteristics were compared between patients who received a K-based doublet, triplet or other regimen (monotherapy or >3 treatments). Results: Of the 718 patients who received a K-based regimen during the study period, 219 (30.5%) had doublet regimens, 287 (40.0%) received triplet regimens and 212 (29.5%) received other regimens; 494 (68.8%) received regimens with ≥3 therapies. Mean age was 69.7 and 64.7 years among patients on doublets and triplets, respectively. A higher proportion of female patients received doublets (53.0%) (Table). There were no differences in ISS stage or number of comorbidities across patients receiving doublets, triplets, or other regimens. Conclusions: In this real-world analysis of K-regimens, a majority of patients received triplet regimens. Older patients received doublet regimens more frequently. The influence of regimen on outcomes controlling for patient characteristics and prior treatments among MM patients receiving K-based regimens should be studied. [Table: see text]

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Poster: MM-123: Real-World Study of Treatment Patterns in Heavily Pretreated Relapsed/Refractory Multiple Myeloma (RRMM) in the US

Clinical Lymphoma Myeloma & Leukemia ◽

10.1016/s2152-2650(21)01589-5 ◽

2021 ◽

Vol 21 ◽

pp. S253

Author(s):

Peter Feng Wang ◽

Leah Sansbury ◽

Maral DerSarkissian ◽

Shannon Ferrante ◽

Rachel Bhak ◽

...

Keyword(s):

Multiple Myeloma ◽

Real World ◽

Treatment Patterns ◽

Refractory Multiple Myeloma ◽

The Us ◽

Heavily Pretreated

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Treatment Patterns and Outcomes of Relapsed/Refractory Peripheral T-Cell Lymphoma (RR-PTCL) Patients Treated in the Community Oncology Setting

Blood ◽

10.1182/blood-2018-99-115437 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 1656-1656

Author(s):

Chadi Nabhan ◽

Jalyna Laney ◽

Joseph Feliciano ◽

Choo Hyung Lee ◽

Andrew J Klink

Keyword(s):

Clinical Trials ◽

Real World ◽

Patient Characteristics ◽

Treatment Patterns ◽

Novel Therapies ◽

Employment Equity ◽

The Real ◽

Community Oncology ◽

The Us ◽

Equity Ownership

Abstract Introduction: The majority of PTCL cases are pathologically heterogeneous, aggressive and chemorefractory; nearly 70% of patients who undergo induction chemotherapy develop RR disease. Data on how RR-PTCL patients are managed outside of clinical trials and academic settings have not been adequately studied. Understanding how PTCL patients are treated in the real world allows better design of future clinical trials and refined development of novel therapies. This study aimed to describe contemporary treatment patterns, clinical characteristics, and overall survival (OS) among RR-PTCL patients treated in the US community oncology setting. Methods: We conducted a retrospective, observational cohort study of RR-PTCL patients treated between 1/1/2010-12/31/2016. Data were collected from patient medical records abstracted from 30 community oncologists across all geographic areas in the US (38% South, 22% West, 7% Midwest, 26% Northeast, and 7% unknown). Patient characteristics, treatment patterns, adverse events (AEs), physician-reported response to first- and second-line (1L, 2L) treatments, and date of death were collected. Descriptive statistics were calculated to summarize patient characteristics and study outcomes. Median (95% confidence interval [CI]) OS from RR disease was calculated by the Kaplan-Meier method. Results: We analyzed 200 RR PTCL patients (71% received CHOP, 20% received CHOEP, and 9% received another regimen as 1L systemic therapy). The majority (58%) were PTCL not otherwise specified (NOS), 61% were males, and median age was 62 years (range: 20-90) (Table). Overall response rate (ORR) to 1L treatment was 80% (CR, 54%; PR, 26%), and ORR to 2L treatment was 55% (CR, 31%, PR, 24%). Among all PTCL patients and among those with PTCL NOS, the OS (95% CI) from RR disease was 13.0 months (95% 7.0-not estimable) and 9.0 months (95% 6.0-not estimable), respectively (Figure). Median time to RR disease from 1L initiation was 12.9 months. Median durations of 1L and 2L treatments were 4.4 months and 3.7 months, respectively. Among those who continued to 2L therapy, 27% received brentuximab vedotin (2% in combination), 19% received ICE (carboplatin/cisplatin, ifosfamide, etoposide), 13% received romidepsin (2% in combination with pralatrexate), 10% received pralatrexate monotherapy, 7% received GEMOX (gemcitabine, oxaliplatin), and the rest (22%) received other 2L regimens or an unknown regimen (2%). After 1L initiation, only 14/200 (7%) received hematopoietic stem cell transplant (HSCT) and 28/151 (19%) after 2L. AEs resulting in a dose reduction, discontinuation, or hospitalization during 1L treatment and occurring among ≥10% included anemia (39%), thrombocytopenia (27%), neutropenia (23%), mouth sores (16%), diarrhea (15%), neuropathy (14%), febrile neutropenia (13%), and vomiting (10%). Conclusions: While response to 1L treatment in this cohort was high (80%), all developed RR disease (or died), for whom the prognosis remains poor. Very few patients underwent HSCT in any line of therapy. Our data demonstrate the unmet medical need for RR-PTCL patients and the need for novel therapies in the 1L setting. It also underscores the need to better understand factors leading to treatment selection and optimal treatment sequencing in the real world. Disclosures Nabhan: Cardinal Health: Employment, Equity Ownership. Laney:Cardinal Health: Employment, Equity Ownership. Feliciano:Seattle Genetics: Employment, Equity Ownership. Lee:Cardinal Health: Employment. Klink:Cardinal Health: Employment, Equity Ownership.

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Real-world treatment patterns of adult multiple myeloma patients treated with carfilzomib in the US community oncology setting.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e19513 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e19513-e19513

Author(s):

Sumeet Panjabi ◽

Rohan Medhekar ◽

Kathleen Aguilar ◽

Thomas Wilson ◽

E. Susan Amirian ◽

...

Keyword(s):

Multiple Myeloma ◽

Treatment Patterns ◽

Immunomodulatory Drugs ◽

Health Records ◽

Treatment Regimens ◽

Community Oncology ◽

The Us ◽

Treatment Administration ◽

Treatment Sequencing ◽

Systemic Therapies

e19513 Background: The purpose of this retrospective cohort study was to describe the treatment regimens received by adult multiple myeloma (MM) patients who were exposed to carfilzomib (K) in the US Oncology Network (USON). Methods: Eligible patients received K-based regimens for MM at least once between 11/01/2013 and 02/29/2016, were ≥18 years old, were not in a clinical trial, and had at least 2 visits at a USON clinic. Data on systemic therapies, lines of therapy (LOT), clinic visits and treatment administration dates were abstracted from the electronic health records (EHR). Treatment sequencing logic was used to identify progression by LOT. Sequencing rules were based on regimens, duration, and administration dates. Treatment regimens utilized at any time during the study period were analyzed by LOT. Results: 718 MM patients received a K-containing regimen at least once over the course of treatment. The frequency distribution of regimens for K-exposed patients by LOT (2 to 5) are provided (see Table). Among these patients, K-based regimens comprised 66.6% of LOT2 regimens, 55.3% of LOT3 regimens, and 45.9% of regimens used beyond LOT3. K+ lenalidomide + dex (KRd) was the most common K-containing regimen used in LOT2 (24.7%). K-triplets containing an immunomodulatory agent were most frequent in LOT 2 and K-doublets (Kd) were most frequent in LOT 3. Conclusions: In our study, K-based regimens were used across LOTs 2 to 5 with highest frequency observed in LOT2. K-triplets with immunomodulatory drugs were more common in earlier LOTs. [Table: see text]

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MM-123: Real-World Study of Treatment Patterns in Heavily Pretreated Relapsed/Refractory Multiple Myeloma (RRMM) in the US

Clinical Lymphoma Myeloma & Leukemia ◽

10.1016/s2152-2650(21)01947-9 ◽

2021 ◽

Vol 21 ◽

pp. S423

Author(s):

Peter Feng Wang ◽

Leah Sansbury ◽

Maral DerSarkissian ◽

Shannon Ferrante ◽

Rachel Bhak ◽

...

Keyword(s):

Multiple Myeloma ◽

Real World ◽

Treatment Patterns ◽

Refractory Multiple Myeloma ◽

The Us ◽

Heavily Pretreated

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Real-World Use of Maintenance Therapy and Associated Outcomes Following Autologous Stem Cell Transplant in US Patients with Newly Diagnosed Multiple Myeloma

Blood ◽

10.1182/blood-2020-139882 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 25-26

Author(s):

Eric M. Ammann ◽

Annette Lam ◽

Wenze Tang ◽

Tobias Kampfenkel ◽

Mohit Sharma ◽

...

Keyword(s):

Multiple Myeloma ◽

Stem Cell ◽

Maintenance Therapy ◽

Clinical Outcomes ◽

Real World ◽

Treatment Patterns ◽

Cell Transplant ◽

Newly Diagnosed ◽

The Us

Background: In patients with newly-diagnosed multiple myeloma (NDMM) who receive frontline autologous stem cell transplantation (ASCT), maintenance therapy (MT) following ASCT has been shown to delay disease progression and death. Current National Comprehensive Cancer Network (NCCN) guidelines also recommend MT for patients with MM, including the use of lenalidomide, bortezomib-based regimens, or ixazomib. However, there is limited evidence on the use and outcomes associated with MT in contemporary real-world patients. The present study assessed MT treatment patterns and clinical outcomes in a real-world US cohort of patients with NDMM following ASCT. Methods: This retrospective, observational cohort study included NDMM patients initially diagnosed from 2011-2018 who received frontline ASCT. Patients were selected from the US Flatiron Health (FH) deidentified electronic health record (EHR)-derived database, which includes longitudinal patient-level data from over 265 community-based and academic cancer clinics across the US. To ensure capture of post-ASCT consolidation and MT, the study sample was restricted to patients who resumed contact within the FH network within 60 days following ASCT. Patients were excluded if they received treatment within the context of a clinical trial or had a second transplant within 180 days of their initial ASCT. Patients were classified as receiving MT if (during the 180-day post-transplant period) they initiated treatment with an NCCN-recommended MT regimen or continued to receive a subset of the antimyeloma agents used as induction regimen following ASCT and consolidation (if any). Key measures included baseline demographic and clinical characteristics, antimyeloma treatments (frontline induction, consolidation, and MT, if any), and clinical outcomes (time to next myeloma treatment [TTNT] and overall survival [OS]). Treatment duration and clinical outcomes were analyzed using Kaplan-Meier estimators and Cox regression to account for right-censoring. For TTNT and OS, follow-up began on the earlier of the ASCT date + 90 days or start of MT and continued through the dataset cut-off date (May 30, 2020) or loss to follow-up; TTNT and OS were estimated for patients receiving lenalidomide maintenance [R-MT], bortezomib maintenance [V-MT], or no MT, but was not estimated for other MT regimens due to sample size considerations. Results: 528 NDMM patients (median age 61 years, interquartile range [IQR]: 55, 68; 45.3% female) underwent ASCT and met study inclusion criteria. The most common induction regimens were bortezomib-lenalidomide-dexamethasone (VRd; 60.0%), lenalidomide-dexamethasone (Rd; 16.3%), and cyclophosphamide-bortezomib-dexamethasone (CyBorD; 10.2%). Following ASCT, 7.2% of patients received consolidation therapy and 74.2% received MT (lenalidomide monotherapy [R-MT]: 58.7%; bortezomib monotherapy [V-MT]: 7.6%; other MT: 7.8%). Median duration of MT was 18.0 months (IQR: 8.7, 29.1), and was similar for R-MT and V-MT (median 18.9 and 18.6 months, respectively). MT use increased from 69.3% to 79.0% from 2011-2013 to 2017-2018 (P=0.04); in addition, patients were more likely to have received VRd as induction across different MT (Table 1). R-MT and V-MT were both associated with longer TTNT relative to no MT (unadjusted hazard ratios [HRs]: 0.29 [95% CI: 0.22, 0.38] and 0.39 [95% CI: 0.25, 0.61], respectively) (Figure 1A). Improvements in OS were marginally significant with R-MT (HR: 0.58 [95% CI: 0.33, 1.00]) and nonsignificant with V-MT (HR: 0.86 [95% CI: 0.35, 2.11]) relative to no MT (Figure 1B); however, the OS estimates are characterized by low precision due to the relatively small number of events observed. Limitations included lack of documentation of reasons for treatment in the FH database, and use of consolidation and MT were inferred from observed treatment patterns; therefore, misclassification of MT was possible. Conclusions: This analysis demonstrates that MT use following ASCT has increased in routine clinical practice in the US since 2011-2013, with R-MT being the most common regimen followed by V-MT. However, a substantial proportion of patients did not receive MT. MT use in real-world settings was associated with longer TTNT and a trend toward longer OS. Exploration of additional maintenance regimens to improve clinical outcomes is warranted in this patient population. Disclosures Ammann: Janssen Scientific Affairs: Current Employment, Current equity holder in publicly-traded company. Lam:Janssen: Current Employment. Tang:Janssen: Current Employment. Kampfenkel:Janssen: Current Employment. Sharma:Mu Sigma: Current Employment; Janssen: Other: Contractor. Lee:Janssen: Current Employment. Kaila:Janssen Scientific Affairs: Current Employment. Fu:Janssen: Current Employment. Gray:Janssen: Current Employment. He:Janssen: Current Employment.

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