Health-related quality of life in patients with triple-class exposed relapsed and refractory multiple myeloma treated with idecabtagene vicleucel or standard regimens: patient-reported outcomes from the phase 3, randomised, open-label KarMMa-3 clinical trial.

BACKGROUND

Chimeric antigen receptor T-cell therapy idecabtagene vicleucel (ide-cel) showed significantly improved progression-free survival compared with standard regimens in adults with relapsed and refractory multiple myeloma who had received two to four previous regimens in the ongoing phase 3 KarMMa-3 trial (NCT03651128). This study analysed patient-reported outcomes (PROs), a KarMMa-3 secondary endpoint.

METHODS

In the randomised, open-label, phase 3 KarMMa-3 trial, 386 patients in hospitals (≥18 years of age, with measurable disease and an Eastern Cooperative Oncology Group performance status score of 0 or 1, who had received two to four previous regimens-including an immunomodulatory agent, a proteasome inhibitor, and daratumumab-and had documented disease progression after receiving their last dose of the last therapy) were randomly assigned to ide-cel (n=254) or standard regimens (daratumumab, pomalidomide, and dexamethasone; daratumumab, bortezomib, and dexamethasone; ixazomib, lenalidomide, and dexamethasone; carfilzomib and dexamethasone; or elotuzumab, pomalidomide, and dexamethasone; n=132). Patients were expected to complete the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life C30 Questionnaire (QLQ-C30), Multiple Myeloma Module (QLQ-MY20), EQ 5 dimensions (EQ-5D), and EQ-5D visual analogue scale (VAS) at baseline and follow-up timepoints (data cutoff April 18, 2022). PROs included nine prespecified primary domains: EORTC QLQ-C30 GHS-quality of life (QoL), physical functioning, cognitive functioning, fatigue, and pain; QLQ-MY20 disease symptoms and side effects of treatment; and five-level EQ-5D (EQ-5D-5L) index score and EQ-5D visual VAS. Differences in overall least-squares mean changes from baseline to month 20 were analysed using post-hoc constrained longitudinal data analysis. Time to confirmed improvement or deterioration from baseline was analysed using Cox proportional hazard models.

FINDINGS

Patients were randomly assigned between May 6, 2019, and April 8, 2022. Overall, the median age was 63 years (IQR 55-68); 151 (39%) patients were female; and 250 (65%) patients were White, 36 (9%) Black or African American, 19 (5%) Hispanic or Latino, 12 (3%) Asian, and seven (2%) of other race. The median follow-up was 18·6 months (IQR 14·0-26·4). PRO compliance was higher than 75% throughout. Overall least-squares mean changes from baseline favoured ide-cel with Hedges' g effect sizes from 0·3 to 0·7 for most domains. Patients in the ide-cel group showed statistically significant and clinically meaningful improvements across the primary PRO domains of interest, with the exception of QLQ-MY20 disease symptoms, side effects of treatment, and EQ-5D-5L index score, which showed improvement across assessment visits but did not exceed the within-group minimally important difference thresholds. The ide-cel group had shorter times to clinically meaningful improvement than the standard regimens group in QLQ-C30 domains except in role functioning, diarrhoea, and financial difficulties; in QLQ-MY20 domains except body image; and in EQ-5D-VAS.

INTERPRETATION

Ide-cel offers improved health-related quality of life compared with standard regimens for patients with relapsed and refractory multiple myeloma after previous lines of therapy. The PRO data highlight the extended QoL benefits of a one-time infusion with ide-cel compared with continuous treatment with standard regimens in the treatment of triple-class exposed patients with relapsed and refractory multiple myeloma.

FUNDING

2seventy bio and Celgene, a Bristol Myers Squibb Company.

Informations de copyright

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Déclaration de conflit d'intérêts

Declaration of interests MD reports payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational events from Amgen, Bristol Myers Squibb, GSK, Janssen, Sanofi, Stemline, and Takeda. KP reports consulting fees from AbbVie, Arcellx, Bristol Myers Squibb, Caribou Science, Cellectis, Genentech, Janssen, Karvopharm, Legend Biotech, Merck, Oncopeptides, Pfizer, and Precision Biosciences. BA reports consulting fees from Amgen, Bristol Myers Squibb, and Janssen; and honoraria for presentations, support for attending meetings or travel, and participation on advisory boards for Bristol Myers Squibb, Janssen, and Sanofi. MC reports consulting fees from Bristol Myers Squibb, Janssen, and Sanofi; and payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational events for AbbVie, Bristol Myers Squibb, and Takeda. AN reports honoraria and participation on advisory boards for Adaptative Biotechnologies, Amgen, BeyondSpring Pharmaceuticals, Bristol Myers Squibb, Cellectar Biosciences, GSK, Janssen, Karyopharm, Oncopeptides, ONK Therapeutics, Pfizer, Sanofi, Secura Bio, and Takeda; research funding to the institution from Aduro Biotech, Amgen, Arch Oncology, Bristol Myers Squibb, Cellectis, Genentech, GSK, Janssen, Karyopharm Therapeutics, Kite Pharmaceuticals, Merck, Pfizer, and Takeda; and grants and research support for investigator-initiated studies from Amgen, GSK, Janssen, Merck, and Takeda. SM reports participation on advisory boards for AbbVie, Amgen, Bristol Myers Squibb, GSK, Janssen, Novartis, Pfizer, Regeneron, Roche, Sanofi, and Takeda. SG reports grants or contracts from Amgen, Actinuum, Bristol Myers Squibb, Johnson & Johnson, Miltenyi, Omeros, and Takeda; leadership or fiduciary role on other board, society committee or advocacy group, paid or unpaid, for Amgen, Actinuum, Bristol Myers Squibb, Kite Pharmaceuticals, Janssen, Jazz Phamaceuticals, Johnson & Johnson, Novartis, Spectrum Pharmaceuticals, and Takeda; and ownership of stock in Bristol Myers Squibb. HE reports consulting fees, payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events, support for attending meetings or travel, and participation on a data safety monitoring board or advisory board for Amgen, Bristol Myers Squibb, GSK, Janssen, Novartis, Sanofi, and Takeda; research funding to the institution from Amgen, Bristol Myers Squibb, GSK, Janssen, and Sanofi; and ownership of stock in Bristol Myers Squibb. SA reports consulting fees from BeiGene, Bristol Myers Squibb, Cellectar Biosciences, GSK, Janssen, Pfizer, Sanofi, and Takeda; and research funding to the institution from AbbVie, Amgen, Ascentage, Bristol Myers Squibb, Cellectar Biosciences, GSK, Janssen, Pharmacyclics, and Sanofi. PR-O reports consulting fees from AbbVie, Bristol Myers Squibb, GSK, H3 Pharmaceuticals, Janssen, Oncopeptides, Pfizer, Roche, and Sanofi; payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational events from AbbVie, Bristol Myers Squibb, GSK, Janssen, and Sanofi; support for attending meetings or travel from Pfizer; and participation on a data safety monitoring board or advisory board for Bristol Myers Squibb and Janssen. LE, DD, TSM, and MPM are employee of Bristol Myers Squibb. LS and SG are employees of Evidera. NC declares no competing interests. MC is an employee of Celgene, a Bristol Myers Squibb Company.