Insufficient standard of care treatments to improve quality of life for patients with multiple myeloma

Patients with multiple myeloma frequently relapse and experience deterioration in their quality of life, according to results from the LocoMmotion study, which also reported that specific patient and disease characteristics are associated with poor efficacy outcomes .

Based on LocoMmotion study results presented at the American Society of Clinical Oncology Annual Meeting in early June 2022.

Specific patient and disease characteristics have also been associated with poor outcomes.

Despite advances in MM therapy, most patients relapse after treatment with standard agents, with each additional relapse and line of treatment leading to deterioration in patients’ HRQoL. The authors suggest that this is an area of ​​urgent clinical need to consider in addressing patient quality of life and planning treatment strategies.

The LocoMMotion study is considered the first prospective, multinational, real-life efficacy and safety study of SOC in heavily pretreated, triple-class exposed patients with relapsed/refractory MM.

The study was conducted at 76 sites in the United States, Belgium, France, Germany, Italy, the Netherlands, Poland, Russia, Spain and the United Kingdom.

In a poster, efficacy outcomes, including overall survival, progression-free survival (PFS), overall response rate (ORR), and duration of response (DOR), were assessed in subgroups of MM patients treated with SOC therapies between August 2019 and October 2020.1

Subgroups were based on treatment history, baseline, or disease characteristics.

During the follow-up period, 248 patients were recruited and treated with a median of 4 cycles of SOC therapy.

Triple-class and penta-drug refractory, poor renal function, presence of extramedullary plasmacytomas, elevated lactate dehydrogenase, International Staging System stage II-III, bone marrow plasma cells ≥ 60%, high-risk cytogenetics and Eastern Cooperative Oncology Group performance ≥ 1 were all associated with generally worse outcomes, compared to patients who did not have these characteristics.

However, patients who were refractory to non-triple class therapy had longer median PFS than patients refractory to triple class therapy. The ORR in all subgroups was 31.5% and the median DOR was 7.7 months.

Age and number of previous treatment lines did not impact efficacy results.

These results show that specific patient and disease characteristics are associated with poor outcomes, which “should be considered when planning treatment strategies for this patient population, including bridging therapy for many patients.” novel treatments such as chimeric antigen-receptor T-cells,” the authors concluded.

The second poster assessed symptoms, functioning, and overall HRQoL using patient-reported outcome (PRO) questionnaires.2 Average questionnaire completion was approximately 78% during SOC treatment and approximately 71% during follow-up.

Of the patients who completed the questionnaires during SOC treatment, most did not achieve significant improvement in PRO scores.

The study found that 62% of patients had no significant improvement in pain symptoms during the first 3 months of treatment, and 54% had no improvement throughout treatment.

Limited gains in HRQOL from baseline during SOC treatment were found, mostly worsening during subsequent treatment.

An association between depth of response and HRQOL was observed, with patients who achieved a very good partial response or better with SOC treatments (12.9%) having significantly better improvements in HRQoL.

The study authors suggest focusing on therapies that can help patients achieve profound responses and delay disease progression, as they are associated with improved HRQoL.

“These data show that existing standard-of-care treatments do not significantly improve health-related quality of life, particularly due to lack of response, highlighting the urgent need for effective therapies that can positively impact patients’ health-related quality of life,” said Michel Delforge, MD, PhD, of the University Hospital of Leuven in Belgium, during his presentation at ASCO.

References

1. Einsele H, Moreau P, De Stefano V, et al. Subgroup analyzes in patients with relapsed/refractory multiple myeloma (RRMM) receiving the actual current standard of care (SOC) in the LocoMMotion study. Presented at: ASCO Annual Meeting; June 3-8, 2022; Chicago, Ill. Poster 8031.

2. Delforge M, Moreau P, Einsele H, et al. Health-related quality of life (HRQoL) in patients with relapsed/refractory multiple myeloma (RRMM) receiving the actual current standard of care (SOC) in the LocoMmotion study. Presented at: ASCO Annual Meeting; June 3-8, 2022; Chicago, Ill. Poster 8030.

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