MM-359 Real-World Treatment Characteristics and Clinical Outcomes in Medicare Beneficiaries With Newly Diagnosed Multiple Myeloma (NDMM) Treated With Bortezomib in Combination With Lenalidomide and Dexamethasone (VRd)

Context: VRd is a standard induction regimen for NDMM, with clinical trials reporting improvement in progression-free survival (PFS) and overall survival (OS), but real-world data on treatment characteristics and outcomes in NDMM patients receiving VRd is lacking. Objective: We assessed patient and treatment characteristics, PFS, and OS in NDMM patients receiving first-line (1L) VRd, stratified by stem cell transplant (SCT) status. Design, Setting, Patients: This retrospective cohort study included adult patients (≥18 years) with MM diagnosis with continuous Part A, B, and D Medicare coverage who initiated 1L MM treatment between 2012 and 2018, using Medicare Research Identifiable Files. Results: A total of 4,266 patients treated with VRd (14.5% with SCT; 85.5% without SCT; 37.2% still on 1L) were identified on 1L amongst 13,573 MM patients (overall sample). The proportion of patients receiving VRd without SCT increased from 18.5% to 26.1% between 2016 and 2018. Irrespective of SCT status, patients receiving VRd were younger, had a better comorbidity profile (anemia [30.1% vs. 32.9%; with SCT (25.1% vs. 30.3%); without SCT (30.9% vs. 33.2%)], and renal impairment (31.2% vs. 41.1%; 24.3% vs. 34.9%; 32.3% vs. 41.8%), and lower mean Charlson Comorbidity Index (2.4 vs. 3.0; 2.2 vs. 2.8; 2.5 vs. 3.0) vs. the overall MM sample. Longer mean duration of therapy and time to next treatment (by 2 and 4 months) were reported for patients receiving VRd vs. the overall MM sample in 1L. Median PFS and OS were longer (23.7 vs. 16.4 months; 61.7 vs. 46.8 months) for patients receiving VRd vs. the overall MM sample in 1L; these findings were consistent regardless of SCT status (with SCT: by 8.1 and 11.6 months; without SCT: by 6.7 and 13.8 months). Conclusions: In a real-world setting, NDMM Medicare beneficiaries receiving VRd had lower comorbidity burden and better clinical outcomes than the overall MM sample in 1L, irrespective of SCT status. Median PFS and OS were shorter than clinical trials evaluating VRd as a standard front-line treatment among NDMM patients with no intent to transplant/no transplant (SWOGS0777; VRd superior to Rd) and in transplant-eligible patients (IFM2009; VRd+SCT superior to VRd).