Impact of patient frailty on the choice of induction treatment for transplant-ineligible (TIE) newly diagnosed (ND) multiple myeloma (MM).

Abstract

e19561 Background: One of the major factors influencing the choice of triplet versus quadruplet therapies in TIE ND MM is performance status (i.e., patient frailty). The IMROZ (NCT03319667) and BENEFIT (NCT04751877) trials both evaluate the efficacy and safety of the quadruplet regimen isatuximab plus bortezomib, lenalidomide, and dexamethasone (Isa-VRd) in TIE ND MM. We evaluated perceptions of the managing providers on the choice of quadruplet versus triplet induction therapy for the TIE ND MM population. Methods: In September and October 2024, US-based hematologists/oncologists convened at two live meetings to discuss healthcare trends in oncology, including the IMROZ and BENEFIT trials. An online premeeting survey was used to collect participants’ demographics. Participants’ experiences and management strategies surrounding TIE ND MM were captured via an audience response system during the live meeting; not all participants answered every question. Responses were aggregated and analyzed using descriptive statistics. Results: Among 94 participants, 83.0% were community providers, saw an average of 20 patients on clinic days, and had a median of 19 (2−49) years in practice. Half of participants (49.6%) reported that 40% or less of their patients with TIE ND MM were initiated on a quadruplet therapy within the past 3 months. Participants reported patient disease risk status (66.7%), patient frailty (53.3%), and treatment efficacy and safety (both 46.7%) as their top 3 factors influencing their preference of quadruplet versus triplet therapy in TIE ND MM. When presented with two standard-risk, 70-year-old patients with TIE ND MM who differed only in frailty (i.e., non-frail and frail), the majority of participants (44.6% and 53.6%, respectively) reported daratumumab plus lenalidomide and dexamethasone (DRd) as their preferred treatment. After reviewing both the IMROZ and BENEFIT trials, the majority of participants shifted their preference to Isa-VRd (44.6% à 73.8%) for the equivalent non-frail patient. For frail patient, while DRd (42.9%) was still the most preferred choice, there was a significant increase in the preference for Isa-VRd (5.8% à 31.0%). Conclusions: We show that the IMROZ and BENEFIT data significantly shifted the preference of induction regimen from DRd triplet in all comers with TIE ND MM to Isa-VRd quadruplet for fit patients. While Isa-VRd quadruplet is still not preferred in the frail population, there was a significant increase in the willingness to use it. This data reaffirms the impact and influence patient frailty and provider education has on the choice of induction therapy in TIE ND MM. Future research is needed to evaluate how other factors, including disease risk status, play a role in decision-making between triplet and quadruplet therapies.