PFS improvements with triplet regimens extends to older adults with multiple myeloma
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ORLANDO – Though older adults with multiple myeloma often fare worse than their younger counterparts, triplet regimens offer similar progression-free survival results regardless of age, according to a poster presenter at the ASH Annual Meeting and Exposition.
“We’ve continued to show that compared to the younger adults, the older adults – particularly those who are 75, 80 or older – continue to have poorer outcomes. But when we look at PFS, there’s no difference in progression free survival by age regardless of the type of regimen (doublet or triplet regimen),” Bindu Kanapuru, MD, of the U.S. FDA, told HemOnc Today. “The older adults including patients >80 years of age seem to do as well as the younger adults with triplet regimens.”
Kanapuru and colleagues analyzed 10 clinical trials (n = 4,766) submitted for approval between 2011 and 2015, grouping participants into four age cohorts: younger than 65 years (47%), 65 years to 74 years (11%), 75 years to 80 years (11%) and older than 80 years (4%). Within those cohorts, they compared doublet and triplet regimens.
PFS was similar between the groups, ranging from 14.3 months (95% CI, 10.3-21) in the oldest cohort to 16.7 months (95% CI, 15.7-18) in the <65 tyear cohort. OS showed a wider spread, ranging from 31.9 months (95% CI, 24.2-42.8) in the oldest cohort to 45.4 months (95% CI, 42.5-49.4) in the youngest cohort.
When analyzed by drug regimen, all age groups had longer PFS when treated with the triplet regimen, Kanapuru showed. In the youngest cohort, the two-drug regimen produced a median 15.3 months PFS vs. 24.1 months with the three-drug regimen. In the oldest cohort, PFS with the two-drug regimen was 12.3 months while the three-drug regimen produced a 21-month PFS.
“With the progression free survival, which is commonly used in multiple myeloma as an endpoint, it shows that there’s no difference by age with the use of these novel regimens,” Kanapuru said.
Overall survival was not as consistently weighted in favor of the triplet regimen, however, and Kanapuru said the follow-up for OS was short to draw any conclusions.
“This is encouraging, but we must understand that these are older adults who are enrolled in trials so they may be healthier than the older adults who are not enrolled in trials,” Kanapuru said. “How we can apply this to people outside of clinical trials needs further consideration. ... But it is encouraging that the PFS and outcomes with the novel drug regimens seem to not differ by age.” – by Katrina Altersitz
Reference: Kanapuru B, et al. Abstract 3194. Presented at: ASH Annual Meeting and Exposition; Dec. 7-10, 2019; Orlando.
Disclosures: Kanapuru reports no relevant financial disclosures.