Myeloma Patient Preferences: HealthTree Decision-Making Survey | Manni Mohyuddin, MD

Hi, my name is Mani Moyuddin. I'm at the University of Utah, Salt Lake City, where I focus on multiple myeloma. I'm proud to share my abstract with you all. So in this abstract, we surveyed over 700 patients and we presented them with four different scenarios based on data from clinical trials where the progression pre-survival differed between the different options presented to the patients, but the overall survival was the same. So let me sort of explain this in a little bit more detail because the terms progression pre-survival and overall survival can be a little technical. So how we describe progression pre-survival to patients was, is that the amount of time during which your myeloma numbers stay under control and you remain symptom free from myeloma. So basically the amount of time that your disease is staying under control or the amount of time that you are in a remission. Now this may not be technically 100% correct, but we did sort of simplify this for patients and overall survival was described as the amount of time during which you're alive. So we presented patients with four different scenarios and the first question was basically four drugs versus three drugs. And we described data from clinical trials. So we presented and we didn't name the drugs, but we just presented people with an option where they were four drugs. There was a slightly higher rate of infections. There was a slightly higher rate of having lower blood counts. And then, but the progression pre-survival was better. The overall survival in a given time period, we had about four years of follow-up was similar. So we presented patients with that option and for this question over 700 people responded and there was often even split where about 50% chose a four drug option and 50% chose a three drug option. The next question was about transplant, but we didn't name transplant. We just described the process that there's some short-term side effects. You are hospitalized for a little bit, but it does improve the progression pre-survival, but it appears that around five years of follow-up, the overall survival is the same. So again, without using those technical terms, describe this to patients. Again, we saw roughly an even split. About 50% chose each option. The third question was about maintenance and this we described using data from a clinical trial called the Forte trial where the combination of carfilzomib and Revlimid was compared to Revlimid alone as maintenance. So we describe what the process entails, right? If with two drugs, you're coming in once every two weeks to get an infusion, this infusion does slightly increase the risk of getting some cardiac complications, getting fevers, getting some infusion reactions. And we just described the numbers and percentages from the trials. And we saw quite a clear difference here where the majority of patients, so over 80% of patients in this scenario, they chose one drug maintenance, even though the one drug maintenance was offering less PFS, but the overall survival was similar. The fourth question was meant to be provocative. This was again based on a data from a clinical trial where a drug improved PFS marginally by about two months. This was a very late line setting but didn't improve overall survival. And this was mostly meant to be a provocative question where there's a drug that's clearly toxic, might lower the numbers a little bit, but isn't really changing your overall trajectory of the disease. It isn't making you live longer. And as expected, over 90% of patients went against this option. Now we did see a clear difference in terms of the demographics of patients. So we noticed that most of our patients were highly educated. There was a preponderance towards women. And we did see that younger patients were more likely to choose more aggressive options as opposed to older people. And that was an interesting analysis. We also included some patients who had precursor disease, because as you know, the Health Tree platform is a very diverse platform that includes people with small ring myeloma and MGUS. So they were also a small proportion of people with those precursor conditions. And their answers, for the most part, were very similar to how answers of people with myeloma were. So the take-home implications is that I think that it's important for us as physicians to really explain what progression-free survival means and describe that to patients and let them make the decision. There are many patients who would prefer less toxicity, even if it comes at the cost of a slightly decreased progression-free survival, as long as overall survival is maintained. So we have to meet patients where they're at. I think progression-free survival is not a perfect endpoint. But it has achieved its goal in terms of getting drugs to market. And I'm thankful that today we have lots of really good options for our patients with myeloma. And all of that has been built on the back of PFS. But when it comes to decision-making and the daily conversations that we have with our patients, I think it's very important to break down this and present this with nuance. I am very honored to have collaborated on this project with many other people that I look up to myeloma, but also most importantly with patient advocates themselves. So from the very inception of this idea, a patient advocate that I'm very fond of who served as a mentor for me and has really opened up my world to how patients perceive things, Catherine Berger. So she was also a key co-author on this abstract. And we've submitted this to a journal. And we hopefully will have a manuscript to share to you in the next few months. So thank you again for having me. Thank you.