SAN DIEGO — Two frontline remedy combos for sufferers with a number of myeloma who aren’t eligible for hematopoietic stem cell transplant are listed as “most well-liked” regimens, in keeping with Nationwide Complete Most cancers Community pointers.
Nonetheless, a brand new evaluation of real-world affected person outcomes means that one routine could also be considerably higher.
The examine discovered that frontline triple remedy with daratumumab plus lenalidomide and dexamethasone led to considerably longer time to subsequent therapy or time to demise in contrast with the triple mixture that features bortezomib as a substitute of daratumumab.
Within the absence of head-to-head randomized managed medical trials, this examine might assist clinicians make extra knowledgeable choices when selecting therapies for sufferers with newly identified, transplant-ineligible a number of myeloma, mentioned investigator Doris Okay. Hansen, MD, from the Moffitt Most cancers Heart & Analysis Institute in Tampa, Florida, who offered discovering from the evaluation on the American Society of Hematology (ASH) annual assembly.
Regardless of the shortage of head-to-head randomized trials on this setting, a number of oblique comparisons have prompt that the daratumumab routine carries an efficacy edge.
For example, an oblique comparability of sufferers who acquired the daratumumab routine within the MAIA trial with those that acquired the bortezomib routine within the SWOG S0777 trial revealed a 40% decrease danger for illness development or demise amongst sufferers handled with daratumumab. Researchers additionally noticed a profit for the daratumumab routine — a 32% decrease danger for illness development or demise — when evaluating affected person outcomes within the MAIA and PEGASUS research.
To extra instantly examine the efficacy of the 2 regimens, Hansen and colleagues combed knowledge from Acentrus, a de-identified tutorial digital medical information database, to seek out sufferers who began a frontline therapy routine for a number of myeloma between January 2018 and Might 2023. The staff used a number of strategies to stability baseline traits between cohorts.
After making these changes, the examine included knowledge on 302 sufferers who acquired frontline remedy with the daratumumab routine and 341 who acquired the bortezomib routine. Sufferers who underwent hematopoietic stem cell transplant earlier than or throughout remedy had been excluded, as had been those that had prior main stable tumors, hematologic malignancies, or amyloidosis.
Throughout a 20.2-month median follow-up for sufferers on daratumumab, 98 (32%) switched to a brand new remedy or died. Throughout a 21.5-month median follow-up for these on bortezomib, 175 (51%) switched remedies or died.
The median time to demise was 37.8 months within the daratumumab group vs 18.7 months within the bortezomib group. General, sufferers who acquired the daratumumab routine had a 42% decrease danger for demise or time-to-next therapy (adjusted hazard ratio [HR], 0.58; P < .001).
Hansen acknowledged a number of limitations of the examine, together with that the info used got here from provider-based information and could also be lacking sufferers who noticed an out-of-network clinician. The database additionally doesn’t embody info on ECOG efficiency standing, affected person frailty, or cytogenetic danger profiles, which can have influenced outcomes.
The end result measure mixed time-to-next therapy and time to demise; nevertheless, Hansen famous, time-to-next therapy shouldn’t be a direct surrogate for progression-free survival.
General, findings from this real-world examine help the usage of daratumumab plus lenalidomide and dexamethasone over bortezomib plus lenalidomide and dexamethasone on this inhabitants of transplant-ineligible sufferers with newly identified a number of myeloma, Hansen concluded.
The examine was supported by Janssen. Hansen reported consulting for Janssen and others, receiving honoraria from OncLive and Survivorship, and different disclosures.
Neil Osterweil, an award-winning medical journalist, is a long-standing and frequent contributor to Medscape.
