Front-line treatment approaches in multiple myeloma: real-world data from a community-based oncology network

Background: The front-line (1L) treatment landscape for newly diagnosed multiple myeloma (NDMM) is rapidly evolving with guidelines endorsing triplet and quadruplet regimens as new standard-of-care. Despite this, real-world evidence on current treatment patterns for NDMM remain limited, especially in community settings, where most care is delivered. This study describes 1L treatment patterns for NDMM using recent data from a large US community oncology network. Methods: This retrospective, observational study analyzed structured and unstructured medical records of patients treated at Texas Oncology. Patients with NDMM (aged ≥18 years) who initiated 1L between January 2015 and December 2022 were included. Patient characteristics, 1L treatment patterns, and temporal trends were described. Results: 3592 patients with NDMM who initiated 1L treatment were included. From 2015 to 2022, there was a nominal increase in the use of triplet regimens (59.9% to 87.6%). Quadruplet regimen use emerged in 2020 and rose from <1% to 9.4% in 2022. Daratumumab-based regimens numerically increased from 2% in 2019 to 29% in 2022. Daratumumab was integral to all quadruplet therapy regimens used by Texas Oncology centers and was predominantly utilized in the DVRd regimen. Conclusion: In this analysis, adoption of novel 1L regimens for NDMM, particularly daratumumab-based triplet and quadruplet regimens, was observed in recent years. However, the use of quadruplet regimens was still low in 2022, highlighting an opportunity for increased quadruplet uptake in the real-world. Future analysis will be essential to quantify the evolving uptake of quadruplet regimens in 1L and their impact on patient outcomes.