TREATMENT PATTERNS AND OUTCOMES IN THE SECOND AND THIRD LINES AND AFTER TRIPLE-CLASS EXPOSURE: SUBANALYSIS OF THE LATIN AMERICAN MULTIPLE MYELOMA REGISTRY STUDY (MYLACRE)

Abstract

Introduction Patterns of care for multiple myeloma (MM) vary across countries. MYLACRE was a non-interventional registry of patients (pts) diagnosed with MM between in Latin America. We analyzed MYLACRE pts treated in the 2nd and 3rd lines of therapy (LOT2 and LOT3), with the objective of characterizing treatment (tx) patterns. We also investigated tx strategies and outcomes in the subset of triple-class exposed (TCE) pts. Objectives Characterizing treatment (tx) patterns. We also investigated tx strategies and outcomes in the subset of triple-class exposed (TCE) pts. Material and methods Data were retrospectively collected, and tx was left to investigators’ discretion. The LOT2 Population comprised all pts who had an entry for the start date of LOT2. The LOT3 Population comprised all pts from the LOT2 Population who had an entry of the start date of LOT3. We defined TCE pts as those who had received ≥1 proteasome inhibitor (PI), ≥1 immunomodulatory drug (IMiD), and ≥1 anti-CD38 antibody, regardless of tx duration. We analyzed TCE pts with at least one subsequent LOT after becoming TCE. We analyzed time to next treatment (TTNT) and overall survival (OS), with TTNT measured between Day 1 of the LOT of interest and Day 1 of the subsequent LOT. Resultados Of the 1029 pts originally analyzed, 405 and 167 entered the LOT2 and LOT3 Populations, respectively. In LOT2, the most frequently used PI, IMiD, and anti- CD38 were bortezomib (41.0%), lenalidomide (41.0%) and daratumumab (26.2%). Other agents used in >10% were carfilzomib (17.0%) and thalidomide (19.3%). The median TTNT was 21.2 months (mo), and median OS was 26.1 mo. In LOT3, Carfilzomib (26.9%), Lenalidomide (34.7%), and Daratumumab (18.6%) were, respectively, the most common PI, IMiD, and anti-CD38. Bortezomib (25.7%) and thalidomide (10.8%) were the next most frequent. The median TTNT was 12.2 mo, median OS was 14.5 mo. A total of 166 (16.1%) pts had a record of tx with ≥1 PI, ≥1 IMiD, and ≥1 anti-CD38 at some point. Of these pts, 48 (48/166=28.9%) initiated a subsequent LOT after TCE and entered the TCE Population. These pts became TCE after LOT1 (n = 5), LOT2 (n = 27), LOT3 (n = 8), or later (n = 8). Considering agents belonging to the PI, IMID, and anti-CD38 classes, Carfilzomib was the agent most frequently used in the first LOT after TCE (52.1%), followed by Lenalidomide (22.9%), pomalidomide (20.8%), Daratumumab (18.8%), and Thalidomide (10.4%). Forty-five TCE pts could be analyzed for TTNT and OS. The median TTNT was 9.5 mo (95% CI, 5.9 to 19.4 mo). The median OS was 13.4 mo (95% CI, 10.6 to 17.7 mo). Discussion and conclusion This snapshot of pts with MM treated in Latin America shows heterogeneity in txs used in LOT2, LOT3, and after TCE status, suggesting a lack of standard of care in the real world. The difference between real-life drug use and international guidelines could also be determined by access barriers. The short OS, especially after TCE, highlights the importance of more effective tx options to improve outcomes. Funding This study was funded by Johnson & Johnson and Legend Biotech USA In.