Results of eight recent clinical trials show that older patients treated for relapsed or refractory multiple myeloma with novel therapies had similar rates of progression-free survival (PFS) as younger patients.
The analysis was presented at the 2017 European Society for Medical Oncology Congress (September 8-12, 2017; Madrid, Spain).
There have been many new antibodies and drugs approved for relapsed or refractory multiple myeloma in recent years. However, the majority of these therapies are not indicated for the patient group in which the disease is most common: those aged 65 years or older.
Thierry Landre, PharmD, department of geriatric oncology, University of Paris (France), and colleagues conducted a meta-analysis of eight separate trials that assessed 5421 patients with multiple myeloma. Among the included trials were CASTOR and POLLUX, which evaluated daratumumab; ELOQUENT-2, which evaluated elotuzumab; ASPIRE and ENDEAVOR, which evaluated carfilzomib; TOURMALINE-MM, which evaluated ixazomib; PANORAMA, which evaluated panobinostat; and VANTAGE, which evaluated vorinostat.
All patients were stratified by age (younger than 65 years or 65 years and older) and hazard ratios for benefit were calculated for the experimental and comparator arms in both age-stratified groups.
After combining the data from all eight trials, the hazard ratio for PFS in the experimental arms was 0.62 for newer agents, relative to the comparator arms.
Results were similar in individual trial and aggregated trial data when the calculations were assessed in patients aged 65-75 years. After combining the entirety of the data, the hazard ration for PFS was 0.67 for newer agents, relative to the comparator arms.
After breaking down PFS by therapy, researchers found that the hazard ratios for patients younger than 65 years and those aged 65-75 years were 0.57 and 0.52, respectively, for monoclonal antibodies. Respective hazard ratios for data with the histone deacetylase inhibitors (panobinostat and vorinostat) were 0.67 and 0.78. Similarly, the respective hazard ratios for the second-generation proteasome inhibitors (carfilzomib and ixazomib) were 0.61 and 0.70.
“The data with the monoclonal antibodies suggest that these drugs actually provide their best results in elderly patients,” commented Evangelos Terpos, MD, PhD, University of Athens, after the presentation, noting the numerical advantage for the hazard ratio in older vs younger patients.
Dr Landre further referenced how this study addresses the gap of “data available for evaluating efficacy in those older than 65 years and older than 75 years of age.”—Zachary Bessette