Multiple myeloma treatment patterns in China: Analysis of the CancerMPact treatment architecture database

Abstract Background The most common treatment classes used for the management of multiple myeloma (MM) include proteasome inhibitors (PIs), immunomodulatory drugs (IMiDs), and anti-CD38 monoclonal antibodies. However, despite these options, patients will likely experience relapse or become refractory to their prescribed regimen and will typically cycle through many subsequent lines of treatment. The practice patterns of MM, particularly among patients with later-line disease, can vary substantially by geography. The present study sought to understand the current management of MM in China. Methods Data from the CancerMPact Treatment Architecture (Oracle Life Sciences, Austin, TX, USA) dataset were analyzed. CancerMPact Treatment Architecture is an annual, online survey administered to board-certified physicians across the United States, France, Germany, Italy, Spain, the United Kingdom, China, and Japan to understand the treatment of 32 different tumors. This study used the China 2024 MM survey, which included hematologists and oncologists. Survey questions asked respondents about their oncology practice experience, patient characteristics of those under their care, and their treatment approaches to MM. Results were reported descriptively. Results Physicians (N=120; 37% hematologists and 35% medical oncologists) with a mean of 17 years of practice experience post-residency who treated a total of 3090 patients with MM completed the survey. Of these physicians, 80% practiced at a Level III hospital; 13% and 8% of the physicians practiced in Beijing and Shanghai, respectively. Based on physician survey responses, 47% of newly diagnosed patients were transplant eligible, a plurality of whom (23%) received RVd as induction; for transplant patients receiving maintenance, Rd (15%) was the most common regimen. RVd was also the most common induction regimen among transplant-ineligible patients (22%). In second line (2L), 42 different treatment regimens were used, and no individual regimen was used by more than 10% of patients. The most common regimens were KPd (10%) and DVd (9%). Daratumamab-based regimens were used in 31% of patients, with the vast majority using a daratumumab + PI-based regimen (27% of 2L patients). In third line (3L), 45 different treatment regimens were used, and no regimen was used by more than 10% of patients; the most common was KPd (9%). Approximately one-third of patients in 3L (32%) used a daratumumab-based treatment regimen, with 75% of those patients (24% of 3L overall) using daratumumab in combination with a PI. The heterogeneity in treatment patterns was similar in both fourth line (4L) and fifth line (5L), as patients in each line were using 49 different regimens, and no individual regimen was used by more than 7% of patients. The most common regimens in the 4L were KPd and DT-PACE-V (6% each), and the most common in 5L were equecabtagene autoleucel and DRVd (7% each). Again, daratumumab-based regimens were common, with 26% and 32% patients receiving them in 4L and 5L, respectively. These regimens were mostly used in combination with PIs (20% and 27% of patients in 4L and 5L overall received a daratumumab + PI regimen). ConclusionsThe results of this study indicated substantial heterogeneity in how MM is managed as no regimen, even in first line, was used by more than one-quarter of the patients. Although there is a lack of clear consensus at the regimen level, there are trends in the overall preferred regimen class. Patients with RRMM (2L-5L) were frequently treated with daratumumab-based regimens, often in combination with PIs, indicating the occurrence of therapeutic class recycling.