1
|
Petrakis I, Kontogiorgis C, Nena E, Delimpasi S, Loutsidi NE, Spanoudakis E, Intzes S, Misidou C, Symeonidou M, Giannakoulas N, Constantinidis TC, Terpos E. Does the Simultaneous Introduction of Several Pharmaceuticals in the Post-Lenalidomide Era Translate to Better Outcomes in Relapse Refractory Multiple Myeloma? Findings from the Real-World Innovation in Multiple Myeloma (REAL IMM) Study. Cancers (Basel) 2023; 15:5846. [PMID: 38136391 PMCID: PMC10741914 DOI: 10.3390/cancers15245846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/12/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Newer methodologies are needed to assess the real-world comparative effectiveness of a "generation" of pharmaceutical innovation versus the prior standard of care. This chart review study aimed to first evaluate the cumulative clinical benefits of pharmaceutical innovation in everyday relapse/refractory multiple myeloma before analyzing findings in the context of respective real-world outcomes from the bortezomib/lenalidomide era. Study endpoints included the 52-week PFS rate in second and third line of therapy (LOT), mPFS-2 across the first and second LOT, the ORR, reasons for discontinuation, and the treatment duration per therapeutic algorithm. Data from 107 patients were collected. The median follow-up was 2.0 years. Of the subjects who met the selection criteria for the second LOT, 72.2% maintained the PFS at 52 weeks. In the third-line setting, the PFS rate at 52 weeks was 63.5%. The mPFS across the first and second, the second, and the third LOTs were 26, 17, and 15 months, respectively. The ORR was 76.1% in the second and 69.7% in the third LOT. After non-response or progression, the main reason for drug discontinuation was treatment intolerability. The second-line ORR and the 52-week PFS rate were similar to previous real-world findings from the bortezomib/lenalidomide era. The cumulative mPFS across the second and third LOTs was higher than the respective mPFS across the first and second LOTs. Despite its limitations, the methodology and findings from this study may be used in future clinical and economic evaluations across all hematological malignancies.
Collapse
Affiliation(s)
- Ioannis Petrakis
- Laboratory of Hygiene and Environmental Protection, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (C.K.); (T.C.C.)
| | - Christos Kontogiorgis
- Laboratory of Hygiene and Environmental Protection, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (C.K.); (T.C.C.)
| | - Evangelia Nena
- Laboratory of Hygiene and Environmental Protection, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (C.K.); (T.C.C.)
| | - Sosana Delimpasi
- Bone Marrow Transplantation Unit, Department of Hematology, Evangelismos Hospital, 10676 Athens, Greece; (S.D.); (N.E.L.)
| | - Natasa E. Loutsidi
- Bone Marrow Transplantation Unit, Department of Hematology, Evangelismos Hospital, 10676 Athens, Greece; (S.D.); (N.E.L.)
| | - Emmanouil Spanoudakis
- Department of Hematology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.S.); (S.I.); (C.M.); (M.S.)
| | - Stergios Intzes
- Department of Hematology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.S.); (S.I.); (C.M.); (M.S.)
| | - Christina Misidou
- Department of Hematology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.S.); (S.I.); (C.M.); (M.S.)
| | - Marianthi Symeonidou
- Department of Hematology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.S.); (S.I.); (C.M.); (M.S.)
| | - Nikolaos Giannakoulas
- Department of Hematology, School of Medicine, University of Thessaly, 41110 Larisa, Greece;
| | - Theodoros C. Constantinidis
- Laboratory of Hygiene and Environmental Protection, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (C.K.); (T.C.C.)
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| |
Collapse
|
2
|
Toppila I, Miettinen T, Lassenius MI, Lievonen J, Bauer M, Anttila P. Characteristics and survival trends in Finnish multiple myeloma patients-a nationwide real-world evidence study. Ann Hematol 2021; 100:1779-1787. [PMID: 33712865 DOI: 10.1007/s00277-021-04481-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/02/2021] [Indexed: 11/25/2022]
Abstract
Current understanding of the epidemiology and outcomes for patients with multiple myeloma in Finland is scarce due to lack of comprehensive real-world evidence in clinical practice. The aim of this study was to gain understanding of epidemiological characteristics and treatment and survival outcomes by utilizing multiple real-world data sources with information of adults treated for active multiple myeloma (MM) during years 2005-2016 in Finland. A total of 3851 adult MM patients with C90.0 diagnosis fulfilling all inclusion criteria were included in the analysis. The average myeloma incidence was six cases per 100,000, which slightly increased (p = 0.011) during the follow-up. The age-standardized incidence was three cases per 100,000 in the years 2005-2016. On average, 25% of patients received autologous stem cell transplantation (ASCT), and this proportion increased during the years 2005-2015 from 17 to 30%. The majority of patients under 65 years of age received ASCT treatment (60.5%), whereas only 8.7% of patients 65 years of age or older were treated with ASCT. The net median overall survival improved by approximately 5 months from 2005-2010 (3.44 years) to 2011-2016 (3.89 years); after adjusting for covariates, this presented an annual 4% reduction in the risk of death. Longer median survival and decreased risk of death indicate improved treatment outcomes from 2005 to 2016 among adult MM patients in Finland.
Collapse
Affiliation(s)
| | - Tatu Miettinen
- Medaffcon Oy, Espoo, Finland
- Takeda Oy, Helsinki, Finland
| | | | - Juha Lievonen
- Department of Hematology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | | | - Pekka Anttila
- Department of Hematology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
3
|
Ntanasis-Stathopoulos I, Gavriatopoulou M, Terpos E, Dimopoulos MA. Real-World Treatment of Patients With Relapsed/Refractory Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:379-385. [PMID: 33714682 DOI: 10.1016/j.clml.2021.01.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 01/18/2023]
Abstract
The continuous advances in the treatment landscape of multiple myeloma has led to the approval of several novel agents and their combinations that significantly improved patient outcomes. Despite their undoubtful effectiveness in the context of clinical trials, their impact on real-world (RW) clinical practice remains debatable. RW data on the role of novel agents and their combinations among patients with relapsed/refractory multiple myeloma have confirmed the efficacy of proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies. However, the magnitude of the benefit and the safety profile may differ among RW studies and between RW and pivotal clinical trials. Several variables may pertain to these observations and include patient selection, ethnicity, age, comorbidities, disease stage at diagnosis and at relapse, number of prior lines of therapy, disease subtype, presence of renal impairment, extramedullary disease, and cytogenetic abnormalities. All these contribute to a varying degree of disease and patient heterogeneity among the studies that may result in a differential treatment effect. The expertise of each medical center and the treatment setting in terms of availability and drug access are particularly important as well. Interestingly, RW observations may serve as proof of concept for designing novel clinical trials, as is the case with retreatment studies. In conclusion, clinical trial and RW data are complementary, and they should be considered to improve both clinical trial design and clinical practice.
Collapse
Affiliation(s)
- Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| |
Collapse
|