Comparisons in Time to Next Treatment in Myeloma Patients | Doris K Hansen, MD | ASH 2023

My name is Doris Henson from Moffitt Cancer Center. Today I'll be presenting our comparison of time to next treatment or death between frontline duotinomal blenolidomidexamethasone or DRD and botosomiblinolidomidexamethasone or BRD in transplanted eligible patients with neurodiagnosis multiple myeloma. Generally clinical guidelines for patients with neurodiagnosis multiple myeloma consider the use of induction chemotherapy followed by high dose chemotherapy such as melforium followed by autologous lymphocytogenesis. However, if somebody is older and they're not frail, transplant may not be an option. So generally the two preferred regimens in the National Comprehensive Care Network guidelines are DRD and BRD as frontline regimens for transplant knowledge by patients. There have been no head-to-head randomized clinical trials, but there's been some other comparative analysis. The objective of our study was to compare the time to next treatment or death between frontline use of DOD versus VOD in transplanted eligible patients with multiple myeloma, but also to add to the possible evidence base regarding comparative effectiveness between these two regimens. So the time to next treatment is a well-established measure and it was chosen for this study because there is a lack of data on progression in these retrospective databases. So the database that we used for this study was the Essentials database, which is a de-identified electronic medical record to essentially re-identify patients treated between January 1, 2018 to May 31, 2023. And we used a type of statistical analysis known as the inverse probability of treatment weighted to essentially adjust baseline characteristics between patients. We identified that 643 patients were eligible for this study. 149 received DRD and 494 received BRD. As I mentioned, we used the inverse probability of treatment weighted to adjust baseline characteristics. After this adjustment, our patient characteristics were fairly similar. We identified mean age to be 75, contrast in comorbidity index was similar. There were some minor imbalances between the groups, but these were adjusted again using a W-repress-cox-repression model. In terms of what are the main results of this study, so the main results of this study is that DRD was associated with a longer time to next treatment or death compared to BRD. In particular, 32% of patients receiving DRD as of the first of 51% had advanced or subsequent therapy or died. It's important to note that DRD was associated with a 42% lower risk of disease or progression to subsequent therapy or dying as evidenced by an adjusted hazard ratio of 0.58. Also, in this study, we showed that the median time to next treatment or death was approximately 38 months for patients receiving DRD and approximately 19 months for patients receiving BRD. Certainly, like any retrospective analysis using the database, the study has limitations. Particularly, there may be administrative censoring or right bias. If patient went out of network, we may have missing information or the central state of the US has some misinformation regarding ECOP performance status or variables required for failed calculation or cytogenetics. I think it's important to also note that time to next treatment is not a direct proxy for professional free survival because it can be impacted by physician and patient decisions regarding starting a subsequent therapy which may not be related to progression by RWG response criteria. In conclusion, our study did show that FRAD9-DRD was associated with a number of time to next treatment or death as evidenced by a 42% risk reduction. Our study does support the use of DRD over BRD similar to the other studies like the Toys, the ChartRuby as well as other adjusted indirect comparisons like Pegasus. Hopefully, in the absence of head-to-head randomized clinical trials, our study does support the clinical effectiveness of DRD and hopefully will assist clinicians in informed decision making for choosing FRAD9 therapy for patients with transplant-related multiple mind-line. Thank you very much.