Real-world treatment patterns and outcomes of triple class exposed (TCE) patients with relapsed/refractory multiple myeloma (RRMM) treated in community and academic oncology practices in the US.

Abstract

e23261 Background: Treatment accessibility for patients (pts) with MM is variable based on care setting. Most novel therapies are approved for RRMM in late lines of therapy (LoT). Starting from 2021, CAR-T and bispecific antibody (BsAb) therapies became available for MM. Herewe evaluate real-world (RW) treatment patterns and outcomes for TCE pts with RRMM receiving care in community care setting (CCS) and academic care setting (ACS), after ≥2 prior LoT. Methods: This retrospective observational study used the COTA Vantage MM database. Care setting was assigned based on the provider site at time of data abstraction. Adults were included if they had TCE (proteasome inhibitor, immunomodulatory drug, and anti-CD38 monoclonal antibody exposure) and initiated 3L therapy in the US between November 2015–May 2024. Index date was defined as start date of each line of interest post-TCE. Pt demographics, clinical characteristics, and RW outcomes were assessed, stratified by care setting. Additional analyses are ongoing. Results: Of the 681 pts included, 34.5% were in ACS and 65.5% in CCS. The mean (SD) age at diagnosis was 64 (10.4) and 65 (10.5) years, and 48.1% and 48.4% were female for ACS and CCS, respectively. Selected pt characteristics and unadjusted RW outcomes by care setting are reported in the Table. In addition, among the observed 631 ACS and 1054 CCS treatment regimens, the top regimens were daratumumab-pomalidomide-dexamethasone and carfilzomib-pomalidomide-dexamethasone; top reasons for treatment discontinuation (DC) were physician-reported progression (31% vs 28%) and toxicity (21% vs 19%); death accounted for 3% and 9% of regimen DC in ACS and CCS, respectively. During the study period, the proportions of pts receiving CAR-T and BsAb were low in both settings but samples sizes were small. Conclusions: RW pt demographics and clinical characteristics differ by care setting for TCE RRMM pts in 3L+, and outcomes are suboptimal in both settings. Despite advances in MM management, this study highlights the need for more efficacious and accessible novel treatments for these pts regardless of treatment setting and may add to the body of evidence for evaluating emerging data from novel therapies (including BsAbs) in RRMM. Setting Academic (n=235;476 patient-lines) Community (n=446;781 patient-lines) ECOG PS a at diagnosis ≥1, n (% among nonmissing) b 79 (59.4%) 178 (52.5%) Median prior LoT, (range) b 4 (3–5) 3 (2–4) Ever received CAR-T post-index date, n (%) b 11 (4.7%) 8 (1.8%) Ever received BsAb post-index date, n (%) b 7 (3.0%) 7 (1.6%) Median rwPFS, months (95% CI) c 3.91 (3.1–5.7) 3.22 (2.8–3.9) Median time to next treatment, months (95% CI) c 4.07 (3.3–4.7) 4.50 (4.0–5.03) Median rwOS, months (95% CI) c 14.9 (12.4–19.5) 11.01 (9.5–12.4) a ECOG PS was missing 43% and 24%. b Assessed at the pt level. c Assessed at the pt-line level.