Advancing adoption of evidence-based quadruplet treatment regimens for newly diagnosed multiple myeloma in community practice: Insights from a quality improvement initiative

Abstract Background Quadruplet regimens (anti-CD38 monoclonal antibody added to the proteasome inhibitor and immunomodulatory drug backbone) have become standard frontline therapies for both transplant-eligible (TE) and transplant-ineligible (TIE) patients with newly diagnosed multiple myeloma (NDMM). However, novel therapy uptake may be delayed in community oncology due to unique challenges in that setting. This quality improvement initiative aimed to assess community clinic-specific practice patterns and identify challenges in NDMM management, to inform the development and implementation of processes to optimize evidence-based integration of quadruplet regimens into routine clinical practice for eligible NDMM patients. Methods This initiative is comprised of baseline (N = 64) surveys, and pre- (N = 60) and post-surveys (N = 43) of providers participating in peer-to-peer exchange sessions between 6 community clinics. Survey questions were designed to uncover real-world care gaps and barriers to identification and utilization of quadruplet therapy in eligible NDMM patients. Care teams from each clinic participated in peer-to-peer exchange sessions facilitated by a MM expert to (a) review similarities and discordances in survey data, (b) participate in interactive peer-to-peer learning discussions regarding clinic processes, and (c) develop clinical solutions to resolve identified gaps. Results Baseline Assessment: Top reported challenges in integrating new therapies into NDMM treatment plans include limited access or insurance coverage issues (69%) and identifying appropriate patients for newer therapies (31%). Providers were more likely to prescribe a quadruplet regimen for a patient with TE than TIE NDMM (65% extremely likely/likely vs. 32%, respectively). Accordingly, within the last year, 66% of providers indicated that most/every patient with TE NDMM received quadruplet therapy, with age/frailty (46%) being the main reason for not receiving quadruplet therapy. Providers reported that the top factors considered most when selecting first-line treatment for NDMM patients were clinical guideline recommendations (66%) and transplant eligibility/ineligibility (59%), with clinical guidelines (84%) and professional network and discussions with peers (36%) being the top strategies community providers rely on to stay informed about novel therapies for MM that help guide treatment decisions. Peer-Peer Exchange Sessions: Providers participating in the sessions reported keeping up with the clinical safety and efficacy data (43%) and gaining approval from the insurance company (40%) as the most significant barriers encountered in adopting quadruplet therapies as frontline treatment for patients with NDMM. Following the session, clinicians reported improvement in high/very high confidence in their ability to identify patients eligible for quadruplet regimens based on transplant eligibility, disease burden, and patient-specific factors (53% to 93%; p < 0.001). Care teams set goals to develop a protocol to identify eligible NDMM patients for quadruplet therapy, educate team members on the clinical data supporting quadruplet therapy, and improve insurance authorization and access to quadruplet therapies. Action plans to achieve these goals included designating a local champion to take ownership, update colleagues, and aid with payer issues; use internal reports to track how often quadruplet therapy is ordered; and distribute concise, high-impact summaries of trial data and guidelines to care team. Conclusions Through this initiative, clinical teams identified barriers to integrating quadruplet regimens into frontline treatment plans for TE or TIE NDMM patients, creating and implementing process improvements including dedicating staff, chart monitoring, and education dissemination to ensure eligible patients are identified and prescribed standard of care treatment. While meaningful action plans addressing underlying root causes of identified gaps were implemented, these data underscore the importance of tailored education of community providers to address in future initiatives to support adoption of quadruplet therapy for NDMM. Study Sponsor Statement The study reported was funded by an educational grant from Sanofi US and Janssen Biotech Inc, administered by Janssen Scientific Affairs both Johnson and Johnson companies, who had no role in the study design, execution, analysis, or reporting.