Second Line Therapy in Multiple Myeloma: A SEER Medicare Analysis

Area of Science:

• Hematology
• Oncology
• Health Economics

Background:

• The treatment landscape for relapsed/refractory multiple myeloma (RRMM) has evolved significantly with numerous drug approvals since 2012.
• Characterizing population-level trends in therapy selection, survival, and cost is crucial for understanding treatment evolution.

Purpose of the Study:

• To analyze trends in therapy selection, overall survival, and costs for patients with relapsed/refractory multiple myeloma.
• To evaluate the impact of newer therapies on treatment outcomes and healthcare expenditures over time.

Main Methods:

• Utilized the SEER-Medicare database (2007-2017) including 9,822 adult patients with multiple myeloma (MM).
• Identified MM-directed therapies and lines of therapy, focusing on second-line therapy (2LT) regimens.
• Analyzed overall survival trends using Cox proportional hazards models and cost trends using JoinPoint analysis.

Main Results:

• Nearly 60% of patients received 2LT, with 46% of 2LT regimens including agents approved after 2012 by 2018.
• Initiation of 2LT in later years was associated with improved overall survival (HR 0.78 per 5 years).
• Mean inflation-adjusted costs for 2LT increased significantly post-2012, with higher costs for regimens containing novel agents ($224,193 vs. $189,381).

Conclusions:

• Overall survival has improved for RRMM patients initiating second-line therapy.
• This survival improvement is accompanied by substantial increases in treatment costs, particularly with novel agents.
• Findings provide essential context for evaluating current and future drug approvals in RRMM management.