EHA: INSIGHT Update on Multiple Myeloma

The European Hematology Association is hosting its conference in Stockholm, Sweden this week, so watch for updates from on the Myeloma Crowd site. 

One update is being presented from Takeda Oncology on their INSIGHT study to better understand how myeloma treatments are being administered in the clinic. There is no standard therapy in the management of newly diagnosed or relapsed multiple myeloma, so the study wants to review real-world data versus controlled clinical trials. 

Notably, the real-world data showed shorter treatment durations, progression-free and overall survival, which means that patients are not getting the therapy that is needed to keep the myeloma in check. 

The INSIGHT study is the largest global observational myeloma study to date. It aims to understand patient characteristics, treatment and clinical outcomes, the link between treatment and 1) effectiveness 2) quality of life and 3) healthcare resource ultization. 

More than 4,000 patients with myeloma will be enrolled from 15 countries in Europe, the United States, Latin America and Asia and followed for more than 5 years. 

Countries

For this update, 1,000 patients had been enrolled in 13 countries: 

• EU: 476 patients
• US: 337 patients 
• Taiwan: 94 patients
• Latin America: 93 patients 

Racial Backgrounds and Age

• 77% White/Caucasian
• 11% Asian
• 8% Black/African American

Median age for newly diagnosed patients was 63. Median age for relapsed/refractory patients was 67. 

Treatments

• Overall 60% were treated at academic centers (not a surprise since this is where the INSIGHT trial was being run). 
• 36% of relapsed/refractory patients had received stem cell transplant in their first line of treatment
• 45% of relapsed/refractory patients had received stem cell transplant in any line of treatment
• 85% were treated outside of clinical trials

Diagnosis

• 29% of patients were diagnosed unexpectedly during blood tests/radiolocial exams
• 34% of patients were diagnosed because of bone pain
• 13% of patients were diagnosed because of weakness/fatigue/anemia
• 6% of patients were diagnosed because of kidney issues

Relapse

• In relapsed or refractory patients, the time to relapse decreased with each subsequent line of treatment 
  • 1st line treatment - 23.4 months to relapse
  • 2nd line treatment - 16.6 months to relapse
  • 3rd line treatment - 10.3 months to relapse

Treatment Preferences

• 31% of newly diagnosed patients and 63% of relapsed/refractory patients were continuously treated until they progressed. 
• Triplet combinations (52%) were preferred over double combinations (24%)
• The most commonly administered treatments or combinations include:   
  • Newly diagnosed patients:
    • Velcade/Cytoxan/Dex (Europe and Latin America)
    • Velcade/Revlimid/Dex (United States)
    • Thalidomide/Dex (Taiwan)
  •  
  • Relapsed/Refractory patients:
    • Revlimid/Dex (Europe, US and Taiwan)
    • Velcade/Thalidomide/Dex (Latin America) 
• Most commonly used drug in any combination was bortezomib. Lenalidomide was most commonly used at relapse. 

The authors conclude by saying that there is no global treatment standard for newly diagnosed or relapsed refractory multiple myeloma. This is potentially due to drug and clinical trial availability and treatment patterns at academic vs. community centers.