Standard-of-Care Treatments Insufficient in Improving QOL for Patients With Multiple Myeloma

Patients with multiple myeloma frequently relapse and experience deteriorating quality of life, according to findings from the LocoMMotion study, which also reported that specific patient and disease characteristics are associated with poor efficacy outcomes.

Existing standard of care (SOC) treatments do not substantially improve health-related quality of life (HRQOL) for patients with multiple myeloma (MM), according to results from the LocoMMotion study presented at the American Society of Clinical Oncology Annual Meeting in early June 2022.

Specific patient and disease characteristics were also found to be associated with poor outcomes.

Despite advances in MM therapy, most patients relapse after treatment with standard agents, with each additional relapse and line of therapy resulting in a deterioration in patients’ HRQOL. The authors suggest this to be an area of urgent clinical need to be considered in addressing patient quality of life and planning treatment strategies.

The LocoMMotion study is believed to be the first prospective, multinational, efficacy and safety study of real-life SOC in heavily pretreated, triple-class–exposed patients with relapsed/refractory MM.

The study was conducted across 76 sites in the United States, Belgium, France, Germany, Italy, Netherlands, Poland, Russia, Spain, and the United Kingdom.

In one poster, efficacy outcomes, including overall survival, progression-free survival (PFS), overall response rate (ORR), and duration of response (DOR), were evaluated in subgroups of patients with MM treated with SOC therapies between August 2019 and October 2020.1

Subgroups were based on treatment history, baseline characteristics, or disease characteristics.

During the follow up period, 248 patients were enrolled and treated with a median of 4 cycles of SOC therapy.

Triple-class and penta-drug refractoriness, poor renal function, presence of extramedullary plasmacytomas, high lactate dehydrogenase, International Staging System stage II-III, bone marrow plasma cells ≥ 60%, high-risk cytogenetics, and Eastern Cooperative Oncology Group performance status ≥ 1 were all associated with generally worse outcomes, compared with patients who did not have these characteristics.

However, patients who were refractory to non-triple class therapy had longer median PFS compared with patients refractory to triple-class therapy. The ORR across all subgroups 31.5%, and the median DOR was 7.7 months.

Age and number of prior lines of therapy did not have an impact on efficacy outcomes.

These findings show that specific patient and disease characteristics are associated with poor outcomes, which” should be considered when planning treatment strategies for this patient population, including bridging therapy for novel treatments such as chimeric antigen receptor-T cells,” the authors concluded.

The second poster evaluated symptoms, functioning, and overall HRQOL through patient-reported outcome (PRO) questionnaires.2 Mean questionnaire completion was about 78% during SOC treatment and about 71% during follow up.

Of the patients who completed the questionnaires during SOC treatment, most did not achieve meaningful improvement in PRO scores.

The study found 62% of patients had no meaningful improvement in pain symptoms during the first 3 months of treatment, and 54% had no improvement during full treatment duration.

Limited gains in HRQOL from baseline during SOC treatment were found, primarily worsening during subsequent treatment.

An association between depth of response and HRQOL was observed, with patients who achieved very good partial response or better with SOC treatments (12.9%) having significantly better improvements in HRQoL.

Study authors suggest focusing on therapies that can help patients achieve deep responses and delay disease progression, as these are associated with improved HRQOL.

“These data show existing standard of care treatments do not substantially improve health-related quality of life, particularly because of the lack of response, highlighting the urgent need for effective therapies that can positively impact patients' health-related quality of life,” said Michel Delforge, MD, PhD, from the University Hospital in Leuven in Belgium, during his presentation at ASCO.

References

1. Einsele H, Moreau P, De Stefano V, et al. Subgroup analyses in patients with relapsed/refractory multiple myeloma (RRMM) receiving real-life current standard of care (SOC) in the LocoMMotion study. Presented at: ASCO Annual Meeting; June 3-8, 2022; Chicago, Illinois. Poster 8031.

2. Delforge M, Moreau P, Einsele H, et al. Health-related quality of life (HRQoL) in patients with relapsed/refractory multiple myeloma (RRMM) receiving real-life current standard of care (SOC) in the LocoMMotion study. Presented at: ASCO Annual Meeting; June 3-8, 2022; Chicago, Illinois. Poster 8030.