PS1-21 TREATMENT STRATEGIES FOR MULTIPLE MYELOMA IN ELDERLY PATIENTS: A NETWORK META-ANALYSIS

Sunday, June 12, 2016
Exhibition Space (30 Euston Square)
Poster Board # PS1-21

Monika Buchberger, MSc1, Ursula Rochau, MD, MSc2, Durda Vukicevic, MD1, Wolfgang Willenbacher, MD3, Anna Chaimani, PhD, MSc4, Orestis Efthimiou, PhD4 and Uwe Siebert, MD, MPH, MSc, ScD5, (1)UMIT - University for Health Sciences, Medical Informatics and Technology, Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, Hall i.T., Austria, (2)UMIT - University for Health Sciences, Medical Informatics and Technology, Institute of Public Health, Medical Decision Making and HTA, Department of Public Health and HTA/ ONCOTYROL - Center for Personalized Cancer Medicine, Area 4 HTA and Bioinformatics, Hall in Tyrol/ Innsbruck, Austria, (3)Internal Medicine V, Hematology and Oncology, Medical University, Innsbruck, Austria, (4)University of Ioannina, Department of Hygiene and Epidemiology, Ioannina, Greece, (5)UMIT, Hall in Tirol (Austria) / Boston (USA), Austria
Purpose: Elderly patients with newly diagnosed multiple myeloma (MM) are usually not considered for stem cell transplantation (SCT). Treatment alternatives for these patients include multidrug regimens combining 2-5 drugs of different classes:  steroids (prednisone (P), high dose dexamethasone (D), low dose dexamethasone (d)), IMiDs (thalidomide (T), lenalidomide (R)), proteasome inhibitors (bortezomib (V)), and alkylators (cyclophosphamide (C), melphalan (M)). Head-to-head comparisons between the different regimens are mostly lacking. Our aim was to examine the comparative effectiveness of different first-line strategies currently in use for patients with MM (> 65 years) ineligible for SCT in terms of overall survival (OS) and progression-free survival (PFS).

Method(s): We performed a systematic literature search in Medline, Embase, Cochrane Library, and CRD databases. We used a random-effects network meta-analysis to estimate pooled hazard ratios with 95% confidence intervals for all treatment comparisons and for each outcome. We ranked the treatments using the surface under the cumulative ranking curve (SUCRA).   

Result(s): The network meta-analysis comprised thirteen randomized controlled trials including 5573 patients comparing eleven treatment strategies. Treatment with VMPT-VT showed a statistically significant (p<0.05) OS benefit compared to MPR and MP regimens. VTD showed a statistically significant survival benefit compared to MP. There was no significant difference between the other treatment strategies regarding OS. In respect of PFS, the VMPT-VT strategy was superior to most of the other treatments. The network meta-analysis showed significantly better PFS for MPR-R compared to CTD, Rd, MPR, MPT and MP. Comparison of Rd-Rd against Rd, MPT and MP showed a significant benefit of Rd-Rd. The analysis showed VTD, MPV and MPT to be favorable compared to MP regarding PFS. Based on the cumulative ranking probabilities, VMPT-VT, VTD, VD, Rd-Rd, and MPV might be more effective than Rd, MPR-R, CTD, MPT, MPR and MP in terms of OS. In respect of PFS, VMPT-VT, MPR-R, Rd-Rd, MPV, and VTD might be more effective than VD, MPR, CTD, Rd, MPT, and MP.

Conclusion(s): Our evidence synthesis suggests that VMPT-VT, MPV, Rd-Rd, and VTD are more effective in terms of OS and PFS than other multidrug regimens for the treatment of elderly patients with newly diagnosed MM. However, further research should be considered to provide information on toxicity, quality of life, and cost-effectiveness for the different therapy approaches.

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