Numerous new treatment options have become available for relapsed/refractory multiple myeloma (RRMM) after a long period in which treatment options were very limited. However, there have been few direct comparisons, making it difficult to evaluate the incremental value of each new regimen. This European-based network meta-analysis sought to synthesize available efficacy data, thereby enabling a comparison of all treatment options. Network meta-analyses are used to provide a complete overview of a treatment’s relative efficacy when head-to-head comparisons are not available.
Researchers performed a systematic literature review to identify and evaluate all publicly available phase 3 randomized controlled trials (RCTs). Additionally, 2 abstracts from international hematology congresses were included to provide the most up-to-date information possible. A conventional network meta-analysis based on progression-free survival outcomes allowed a comparison of all available treatment options. The oldest treatment, dexamethasone, was used as reference treatment.
Researchers identified 17 RCTs including 16 treatment options: dexamethasone (Dex), oblimersen-dexamethasone (OblDex), thalidomide/thalidomide-dexamethasone (Thal/ThalDex), bortezomib/bortezomib-dexamethasone (Bor/BorDex), lenalidomide-dexamethasone (LenDex), pegylated doxorubicin-bortezomib (PeglDoxBor), bortezomib-thalidomide-dexamethasone (BorThalDex), vorinostat-bortezomib (VorinoBor), panobinostat-bortezomib-dexamethasone (PanoBorDex), carfilzomib-lenalidomide-dexamethasone (CarLenDex), pomalidomide-dexamethasone (PomDex), elotuzumab-lenalidomide-dexamethasone (EloLenDex), carfilzomib-dexamethasone (CarDex), ixazomib-lenalidomide-dexamethasone (IxaLenDex), daratumumab-lenalidomide-dexamethasone (DaraLenDex), and daratumumab-bortezomib-dexamethasone (DaraBorDex).
As a result of their analysis, which included repeated modeling simulations as well as hazard ratio comparisons, the researchers ranked DaraLenDex as the most effective therapy. DaraLenDex reduced the risk of progression or death in 87% of simulations versus Dex, 80% versus Bor/BorDex and 63% versus LenDex. LenDex performed better than Bor/BorDex in ranking (7th vs 13th) as well as in hazard ratio. Notably, lenalidomide was a component of 4 of the top 5–ranked regimens. Fourteen of 16 treatments were significantly better than Dex, and 11 treatments reduced the risk of progression or death with more than 50%.
When compared with other treatment regimens for relapsed/refractory multiple myeloma, this meta-analysis identified DaraLenDex as the most effective option. As more data on newer agents become available, meta-analyses may take on an increasingly important role in helping clinicians to identify optimal treatment regimens for patients with multiple myeloma.
Van-Beurden-Tan CHY, et al. ASH 2016. Abstract 2144.
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