A thoughtfully developed tracker can provide deep insights on any therapeutic area. Using the results of a syndicated AplusA tracking study on the multiple myeloma market, this series of blog posts look at the key insights that such a tracking study can provide.

To access a full overview of insights from this MM study, read the full eBook here.

Tracking studies can be the ideal solution for gaining long-term insights on patient-related indicators. Here, using AplusA’s syndicated MM tracker as an example, we pose several questions that you may have about your target patient population.

Firstly, let’s consider the patient characteristics across the European MM market. 

What is the typical MM patient profile?

Across top-5 EU countries, the average MM patient is 68 years old, presents at stage III disease, has good performance status, a standard to intermediate cytogenetic profile, and at least one comorbidity, most often hypertension.  Approximately 55% of treated patients are in 1st line, 20% are in 2nd line, 15% are in 3rd line, and 10% are receiving therapy in 4th and later lines.  If you consider later-line patients, 25% have received a transplant, 1% have received two transplants, and almost 10% have delayed their transplant. Here different patient characteristics may lead physicians to different decisions.

Current profile of first-line patients not receiving transplant

With a mean age of 74 years, first-line patients not receiving transplant are older than those who receive transplants. Just over 90% of non-SCT patients are ineligible for transplantation. Also, 80% have at least one co-morbidity, with hypertension and renal deficiency being the most prevalent. Almost 20% of these patients suffer from neuropathy and 20% have moderate to severe renal insufficiency, which influences the choice of therapy for them.

How does this profile differ between Revlimid® (lenalidomide) and Velcade® (bortezomib) patients?

First-line non-SCT Revlimid® patients14 are slightly older than average, and more have an ECOG score of 2 or higher.  Also, more patients with neuropathy and/or cardiac issues are treated with Revlimid® than first-line non-SCT patients overall.  Fewer patients with renal sufficiency and/or prior deep vein thrombosis, however, are treated with Revlimid®.

Velcade® patients are slightly younger and have a slightly better ECOG score than first-line non-SCT patients overall. As would be expected due to their respective side effect profiles, more patients with renal insufficiency and/or high-risk cytogenetics (e.g., chromosome 13, del17p3, t (4;14)) are treated with Velcade® rather than Revlimid®, and fewer patients with neuropathy receive Velcade®.

What is the current profile of first-line transplant eligible patients?

First-line transplant eligible patients are relatively young with an average age of 59 years. About 1/3 have a high-risk cytogenetic profile while only 10% have an ECOG score of 2 or more; therefore, the vast majority of these patients are asymptomatic or symptomatic but completely ambulatory. In fact, 45% of these patients have no co-morbidities.  For those who do, about 5% suffer from neuropathy and 10% have moderate to severe renal insufficiency - both much lower than for patients not receiving transplantation.

What is the current profile of second-line patients?

Second-line patients closely match the typical multiple myeloma patient. Their mean age is 69 years. 70% have an ECOG score of 0 to 1, approximately 75% have a standard or intermediate cytogenetic profile, and more than 85% have at least one co-morbidity, primarily hypertension. By second line, about 25% have developed neuropathy, and 15% have moderate to severe renal insufficiency.

How does this profile differ by the two leading second-line regimens, specifically for Revlimid® and Kyprolis®?

Patient profiles suggest that less-severe patients generally receive the regimen of Kyprolis® (carfilzomib), a proteasome inhibitor, added to Revlimid® and dexamethasone (KRd) and more severe patients receive only Revlimid® and dexamethasone (Rd).  KRd patients are younger, averaging 65 years vs. almost 75 years for Rd. They have lower ECOG scores, lower ISS stage disease, fewer cytogenetic risk factors, and fewer co-morbidities, including renal insufficiency, diabetes, and cardiac-related.

For more information on patients in third and later lines of treatment, as well as more insights from this syndicated study, download the full ebook here:

Source: AplusA Syndicated Multiple Myeloma Tracker 2019