Objective:

To describe real-world treatment patterns and clinical outcomes among patients with relapsed/refractory multiple myeloma receiving second-, third-, or fourth-line therapy across Asia.

Approach:

• Design and setting: Retrospective, multicenter chart-based observational study across six Asian countries and regions, covering patients treated during 2020–2022.
• Participants: The study included 1,123 patients: 626 receiving second-line, 341 third-line, and 156 fourth-line therapy.
• Outcomes: Progression-free survival was the primary endpoint. Secondary outcomes included overall response rate, time to next treatment or death, overall survival, and prognostic factors.

Key Findings:

• Treatment was highly heterogeneous: 75 regimens were recorded in second line, 79 in third line, and 52 in fourth line. Triplets were the leading strategy at every line, followed by doublets; monotherapy became more common at later lines.
• Treatment patterns varied geographically. Mainland China favored triplet- and quadruplet-based regimens, Korea more often used doublets in third line and monotherapy in fourth line, and Japan primarily used anti-SLAMF7-based regimens.
• Outcomes worsened across successive treatment lines: overall response rates were 71.6%, 58.9%, and 43.6% in second, third, and fourth line, respectively; median progression-free survival was 16.1, 9.1, and 5.2 months.
• Median time to next treatment declined from 26.3 months in second line to 15.1 months in third line.
• Greater drug-class refractoriness was associated with poorer outcomes. Among triple-class refractory patients, median progression-free survival was 6.1, 8.1, and 3.8 months in second, third, and fourth line, respectively.

Interpretation:

The authors report substantial regional variation in treatment selection and worsening outcomes across successive treatment lines. They state that treatment heterogeneity reflected differences among healthcare systems, reimbursement models, regulatory approval timelines, and access to novel therapies; treatment selection was also described as reflecting access and reimbursement predominantly rather than intrinsic biological variation.

Limitations:

• The retrospective observational design may limit interpretation of comparisons across countries and regions.
• The large number of distinct regimens prevented robust regimen-specific analyses.
• The authors advise caution when comparing countries; the supplied article context does not include the full discussion or all study limitations.

Conclusion:

This multinational real-world study describes diverse treatment practices and worsening outcomes across successive lines of RRMM therapy in Asia, with greater drug-class refractoriness associated with poorer outcomes.

Sources:

• Article context supplied by the user