Duration of Treatment of Multiple Myeloma Regimens in Patients with Relapsed or Refractory Multiple Myeloma: Findings in US Clinical Practice Settings

Introduction: Many new treatments and combinations have emerged over the last decade to treat relapsed or refractory multiple myeloma (RRMM). Treatment strategies include doublet and/or triplet combinations from the following classes of agents: immunomodulatory drugs, proteasome inhibitors, and recently approved immuno-oncology agents. Combinations with new agents like pomalidomide, carfilzomib, ixazomib, elotuzumab, and daratumumab have demonstrated improved survival in RRMM in clinical trials, specifically with continued treatment until disease progression, with an acceptable safety profile (Lonial S et al. N Engl J Med2015; Dimopoulos M et al. N Engl J Med2016; Palumbo A et al. N Engl J Med2016; Moreau P et al. N Engl J Med2016; Stewart AK et al. N Engl J Med2015; Dimopoulos M et al. Blood2012). Median duration of treatment (DoT) was described in the literature as 12.4 wk for pomalidomide plus low-dose dexamethasone, 68 wk for ixazomib plus lenalidomide/dexamethasone, 74 wk for elotuzumab plus lenalidomide/dexamethasone, and 88 wk for carfilzomib plus lenalidomide/dexamethasone (Lonial S et al. N Engl J Med2015; Moreau P et al. N Engl J Med2016; Stewart AK et al. N Engl J Med2015; Dimopoulos M et al. Blood2012). The actual DoT of these agents in clinical practice settings is not known and it is unclear if DoT is affected by safety concerns and/or might have an impact on patient (pt) outcomes. Here we provide real-world evidence of DoT and time to next therapy (TTNT) with each of these agents in an attempt to understand their potential for durability of response and tolerability.