Treatment Patterns, Goals, and Decision-Making Criteria for Second- and Third-Line Therapies for Multiple Myeloma in Germany.

introductionTo document the decision-making criteria physicians use when selecting regimens for second- and third-line therapy for patients with relapsed and/or refractory multiple myeloma (RRMM) in Germany.

methodsExperienced multiple myeloma (MM) physicians extracted data from medical records from 30 June to 8 September 2023 for patients who initiated approved second- and third-line therapy for MM in 2021. Regimens, most important treatment goal, and key reasons for prescribing were reported in addition to patient characteristics. All data were summarised descriptively.

resultsMM physicians (33 hospital-based, 16 office-based) with a median of 17 years of treatment experience extracted data from a total of 268 patient records (second-line, n = 170; third-line, n = 98). In second- and third-line, 17 and 16 different regimens were documented, respectively. The most utilized second-line regimens were: daratumumab (D), lenalidomide (R) and dexamethasone (d) (DRd 16.5%); carfilzomib (K), d and D (KdD 12.4%); Kd (11.2%); KRd; (10.0%); D, bortezomib (V) and d (DVd 9.4%); and V with cyclophosphamide (C) and d (VCd 7.1%). The main reasons for selecting the regimen were treatment effectiveness, patient characteristics/status, and relapse. Inducing deepest possible response and prolonging survival or symptom control were the most important treatment goals for triplet regimens. The main third-line regimens were: pomalidomide (P) and d (Pd 15.3%); DRd (13.3%); Rd (13.3%); elotuzumab (E) and Pd (EPd 12.2%); isatuximab (Isa) and Kd or KdD (10.2%); and ixazomib (I) and Rd (IRd 8.2%). The main reasons for selecting the regimens varied for third-line regimens but primarily focused on treatment effectiveness, patient characteristics/status, and prior therapy response or mechanism of action. The most important treatment goal was prolongation of survival.

conclusionThe results suggest that in the absence of a single standard of care for RRMM, prescribers made patient-centred choices of regimens with efficacy as the main goal of therapy.