Triplet Therapy Is the Predominant Front-Line Regimen for Multiple Myeloma in the US

The predominant front-line treatment regimen for multiple myeloma (MM) over the past nine years was a triplet regimen, most commonly containing an immunomodulatory agent (IMiD), proteasome inhibitor, and a steroid, according to the results of a recent study.

In fact, the proportion of patients who received triplet regimens increased from around one third (36%) of patients in 2011 to more than two-thirds (72%) in 2019.

“The breadth and timing of treatment patterns for MM have been examined periodically; however, there is a need to understand the most current real-world treatment practices and outcomes in this rapidly evolving environment,” study researchers wrote.

To do that, the researchers assessed types of therapies, time to next treatment (TTNT), and overall survival in 6,271 adults diagnosed with MM from the Flatiron Health electronic-health record de-identified database.

In 2011, front-line regimens were most often doublets (48%) compared with triplets (36%). However, by 2019 the most common regimens were triplets and the use of doublets decreased by 60%.

The median TTNT was 46.7 months during the study period. From 2017 to 2019, the median TTNT from front-line to second-line therapy was longer in patients with International Staging System stage I versus stage II/II disease and those who received an IMiD-based doublet or triplet regimen.

The median overall survival was 56 months, with the median decreasing with higher ISS stage. Patients who received triplet regimens had the longest median overall survival of 70 months. From 2011 to 2014, there was a 10-month increase in median overall survival.

“Of note, the results of our study do not fully reflect the introduction of novel therapies approved for front-line MM in the 2018 to 2019 time period, specifically the anti-CD38 monoclonal antibody daratumumab, with the ALCYONE and MAIA trial results first reported in 2018 and 2019, respectively,” the researchers noted. “The MM treatment landscape has evolved rapidly and continues to do so, offering new options for patients and treating physicians as reflected in the paradigm shift of prescribed treatments observed in this analysis.”