Comparative Efficacy of MM Therapies for Treatment of First Relapse: A Systematic Literature Review and Network Meta-Analysis

Conference Correspondent - ASCO 2017

Carfilzomib, lenalidomide, and dexamethasone (KRd); carfilzomib plus dexamethasone (Kd); daratumumab, lenalidomide, and dexamethasone (DRd); daratumumab, bortezomib, and dexamethasone (DVd); ixaxomib, lenalidomide, and dexamethasone (IRd); and elotuzumab, lenalidomide, and dexamethasone (ERd) have all emerged as therapeutic options for relapsed/refractory multiple myeloma (RRMM) in recent years. These new therapies have shown improvements in clinical outcomes in randomized, controlled trials. However, the availability of head-to-head clinical trials is scant, and there is limited evidence available to determine the most effective treatment for specific patients. A systematic literature review and network meta-analysis were conducted to determine the comparative efficacy of MM therapies for treating first relapse.

The systematic literature review included searches of the MEDLINE and Embase databases, as well as the Cochrane Library, for randomized, controlled trials investigating the efficacy of treatments for patients with RRMM. This study divided the data collected into 2 groups: group 1 focused on clinical trials that examined lenalidomide and dexamethasone (Rd), and group 2 examined studies that included bortezomib and dexamethasone (Vd). The network analysis showed that the addition of daratumumab to either lenalidomide and dexamethasone in DRd or bortezomib and dexamethasone in DVd had the highest probability of being the best treatment based on progression-free survival (PFS) in patients with RRMM (0.96 and 0.89, respectively). Compared with other MM therapies, DRd and DVd had the lowest risk for disease progression or death (PFS hazard ratio [HR] <1.0). When the DRd regimen was compared with KRd, DRd showed a 41% (PFS HR 0.59) reduced risk for disease progression or death, although the result did not reach statistical significance.

This network analysis provides comparative evidence among treatments where head-to-head randomized controlled trials have not been conducted. For treating first relapse, compared with other MM treatments, this analysis showed that the addition of daratumumab to either Rd or Vd resulted in the highest probability of better PFS outcomes.

Maiese EM. ASCO Abstract 8042.