Improving Health Outcomes Through Treatment Sequencing Optimization in Multiple Myeloma: A Simulation Model in...

Area of Science:

• Hematology
• Oncology
• Pharmacoeconomics

Background:

• Multiple myeloma treatment often involves multiple lines of therapy.
• Treatment sequencing impacts patient outcomes, including progression-free survival (PFS) and overall survival (OS).
• Identifying optimal sequences is crucial for transplant-ineligible patients.

Purpose of the Study:

• To estimate PFS and OS for common treatment sequences in Portugal.
• To determine the incremental survival benefit of an optimal sequence in transplant-ineligible multiple myeloma patients.
• To evaluate the impact of first-line treatment choice on overall survival.

Main Methods:

• A state-transition sequential model with five health states was developed.
• Simulations compared survival outcomes for up to four lines of treatment.
• Data from randomized clinical trials and indirect treatment comparisons were utilized, informed by Portuguese hematologists' expert opinion.

Main Results:

• Common sequences yielded an OS of 6.1–7.8 years.
• The most effective common sequence (VMP+DRd+Pd+Kd) resulted in 7.8 years OS.
• An optimal sequence (DRd+PVd+Kd+Vd) achieved 9.8 years OS, a 2.0–3.7 year increase (26%–61% improvement).
• This benefit was primarily driven by extended first-line PFS.

Conclusions:

• Upfront selection of effective treatments is critical for delaying disease progression and improving survival in transplant-ineligible multiple myeloma.
• Daratumumab-based regimens demonstrated a clear survival benefit in the first line of therapy.
• Awareness and implementation of optimal sequencing strategies are needed to enhance patient outcomes.