Recent real-world treatment patterns and outcomes in US patients with relapsed/refractory multiple myeloma.

BACKGROUND: In patients with relapsed/refractory multiple myeloma (RRMM) previously receiving 1-3 therapy lines, newer agents demonstrated improved outcomes versus older agents. Real-world treatment pattern data are limited. We assessed real-world treatment patterns and outcomes in patients with RRMM (≥2 prior therapy lines). RESEARCH DESIGN AND METHODS: An electronic medical record (EMR) analysis and chart review were conducted using International Oncology Network (ION) EMR data. Patients ≥18 years old initiating first-line MM treatment 1 January 2011, to 31 May 2017, were stratified into older/newer treatment cohorts (approval date before vs during/after 2012). Treatment patterns and outcomes were described; no statistical tests were performed. RESULTS: In the EMR analysis (n = 1601) and chart review (n = 456), bortezomib, lenalidomide, and bortezomib-lenalidomide combinations dominated first-line treatment. Median real-world progression-free survival (rwPFS) was 12.0 to 3.5 months (first- to fifth-line), and median real-world overall survival (rwOS) was 48.2 to 5.8 months. A trend for increased rwPFS/rwOS with newer versus older treatments was observed. Most common AEs were fatigue, bone pain, and anemia. EXPERT OPINION: Real-world data describing treatment patterns in relapsed/refractory multiple myeloma are limited. Evaluation of new treatments on patient outcomes will influence treatment patterns and patient outcomes in the real-world setting. CONCLUSIONS: Although a trend for improved rwPFS and rwOS with newer versus older treatments was suggested, additional treatment options to improve patient outcomes are needed.

Hemoglobin trends and anemia treatment resulting from concomitant chemotherapy in community oncology clinics.

PURPOSE: This study describes changes in hemoglobin (Hb) levels in patients during chemotherapy before anemia treatment and in those who received no treatment, measuring time from chemotherapy initiation to Hb less than 10 g/dL and anemia treatment initiation. PATIENTS AND METHODS: This retrospective longitudinal cohort study used a database of outpatient oncology practice electronic medical records from January 1, 2006, to August 6, 2009. Unit of analysis was episode of chemotherapy care, beginning at initiation and including consecutive administrations within the next 60 days. Patients received two or more administrations of conventional chemotherapeutic agents, had a cancer diagnosis with at least 60 days of follow-up, and had no myelodysplastic syndrome. A total of 4,864 episodes (4,021 patients) met selection criteria, 73% with baseline Hb of 11 g/dL or greater and 60% receiving no anemia treatment. RESULTS: Episodes without anemia treatment increased from 44.6% (2006) to 77.8% (2009). Erythropoiesis-stimulating agent (ESA) use decreased from 45.4% (2006) to 11.5% (2009). Patients receiving transfusions increased from 3.4% to 8.7% (2006 to 2009; all P < .001). Total proportion of episodes with Hb less than 10 g/dL at anemia treatment increased from 16.2% to 93.1% during the same period (P < .001). Mean Hb values before anemia treatment decreased over time from 10.8 to 8.9 g/dL (2006 to 2009; P < .001). Overall, time from chemotherapy initiation to first anemia treatment increased from 24.7 to 36.9 days (2006 to 2009; P < .01). CONCLUSION: Results suggest increased restrictions were associated with decreased use of ESAs and increased use of transfusions as well as delays in anemia treatment and lower Hb levels before anemia treatment. Additional investigation of the overall impact of delayed treatments on long-term patient outcomes is warranted.

Surveillance and treatment of non-muscle-invasive bladder cancer in the USA.

Seventy percent of newly diagnosed bladder cancers are classified as non-muscle-invasive bladder cancer (NMIBC) and are often associated with high rates of recurrence that require lifelong surveillance. Currently available treatment options for NMIBC are associated with toxicities that limit their use, and actual practice patterns vary depending upon physician and patient characteristics. In addition, bladder cancer has a high economic and humanistic burden in the United States (US) population and has been cited as one of the most costly cancers to treat. An unmet need exists for new treatment options associated with fewer complications, better patient compliance, and decreased healthcare costs. Increased prevention of recurrence through greater adherence to evidence-based guidelines and the development of novel therapies could therefore result in substantial savings to the healthcare system.