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    Treatment of Newly Diagnosed Myeloma (excluding t-cell redirection therapy)

    Real-World Evidence of Proteasome Inhibitors, Immunomodulatory Drugs and Anti-CD38 in Patients with Multiple Myeloma Treated in Brazil: TOTEMM-B Study Insights

    P-320: Real-World Evidence of Proteasome Inhibitors, Immunomodulatory Drugs and Anti-CD38 in Patients with Multiple Myeloma Treated in Brazil: TOTEMM-B Study Insights

    Wednesday, September 25, 2024
    Introduction: Patients with multiple myeloma (MM) are exposed to different treatment regimens; however, the frequency with which standard care agents are used and the combinations used in clinical practice for MM in Latin America are unknown. The TOTEMM-B study is a real-world data study conducted to describe the treatment patterns and clinical outcomes of patients with MM in Brazil. Here, the proportion of patients exposed to first-line (1L) monotherapy or combination therapy with a proteasome inhibitor (PI), immunomodulatory drug (IMiD), or anti-CD38 agent (monoclonal antibody) is described.

    Methods: Retrospective analysis was performed using administrative claims data from Orizon (January 2015–June 2021). Index was a proxy of diagnosis and could be the first ICD-10 (C.90) procedure, exam, or treatment for MM. Adults aged ≥18 years with ≥1 MM ICD-10 health term and treatment (stem cell transplant [SCT] and/or antineoplastic drug [AD]) and ≥12 months of follow-up after index were included. Incident cases included patients who were treatment naïve for ≥1 year before MM index (after January 1, 2016). The frequency of monotherapy or combination therapy with a PI, IMiD, or anti-CD38 at 1L and the most used AD in each therapeutic class were described.

    Results: In total, 736 patients with MM from the incident cohort were included. Mean (standard deviation) age was 61.9 (11.3) years. Around one-third of patients were treated with SCT (n=237; 32.3%); 728 patients received ≥1 AD. Among these, 83.5% received PI (n=608), 14.4% received anti-CD38 (n=105), and 7.6% received IMiD (n=55). The most used AD in each class was bortezomib, daratumumab, and lenalidomide, respectively. Monotherapy was received by 10.7% (n=78) of patients, with 39.7% of patients receiving a PI (n=31). Almost one-quarter (n=165; 22.7%) received dual therapy; PI + chemotherapy was most used, received by 33.3% (n=55) of patients, with bortezomib + cyclophosphamide/zoledronic acid the most common combination. Approximately, two-thirds (n=424; 58.2%) received triple therapy, with a majority receiving PI + chemotherapy + steroids (n=360; 84.9%), and 8.0% receiving anti-CD38 + PI + steroids (n=34%); bortezomib + cyclophosphamide/zoledronic acid+ dexamethasone, and daratumumab + bortezomib + dexamethasone were the most used combinations, respectively. Quadruple therapy was received by 8.4% (n=61) of patients, and among them, 72.1% (n=44) received anti-CD38 + PI + chemotherapy + steroids; a majority received daratumumab + bortezomib + zoledronic acid + dexamethasone.

    Conclusions:
    Bortezomib, daratumumab, and lenalidomide were the most used ADs in 1L treatment for MM in the Brazilian private care setting, in line with most global guidelines. However, use of lenalidomide was slightly lower compared with use in developed countries, probably due to later (2017) regulatory approval and barriers to reimbursement in Brazil. A similar pattern was observed for the use of daratumumab as 1L therapy.