Physician decision-making on use of treatments for relapsed/refractory multiple myeloma (RRMM) in later lines: What drives preferences?

Abstract

239 Background: Physicians consider many factors when selecting third line or greater (3L+) treatments for RRMM, such as patient age and treatment- and disease-specific factors. A greater understanding of preferences that drive treatment decision-making in RRMM in later lines is important. This study assessed treatment preferences of US hematologists/oncologists and oncologists (HemOnc/Oncs) for RRMM patients in 3L+. Methods: A targeted literature review informed a discrete choice experiment (DCE) survey aimed at identifying treatment preferences. Qualitative interviews with HemOnc/Oncs and a pilot DCE survey were then administered to test the validity of the study attributes. The three versions of the final survey varied in presented patient profiles (3L; 4L; 5L). Participating HemOnc/Oncs were presented with 20 DCE choice tasks; in each task, they were asked to choose between pairs of hypothetical treatments including varying levels for each attribute: overall survival (OS), overall response rate (ORR), progression free survival (PFS), keratopathy (corneal epithelium changes with/without symptoms), thrombocytopenia, neutropenia, steroids, preparations, mode of administration, and drug regimen frequency of administration. DCE data were analyzed using multinomial logit regression (MLR) to estimate treatment preferences for each profile; 4L and 5L data were combined (4L+) because patient profiles were comparable. Mean relative importance of the attributes were estimated. Results: The DCE survey was completed by 227 HemOnc/Oncs (N=227); 3L (n=83), 4L (n=73), or 5L (n=71). For 3L and 4L+, as predicted, OS had the highest mean relative importance of the attributes relative to other attributes (3L: 38.1%; 4L+: 36.5%) (Table); the lowest relative importance was whether the treatment required additional preparations for administration (3L: 1.3%; 4L+: 2.1%). Results of the MLR showed that physicians preferred treatments with decreased Grade 3/4 keratopathy risk of 0% compared to 25% (3L: odds ratio [OR] 1.22, p < 0.0001; 4L+: OR 1.12, p < 0.01); physicians also preferred treatments with decreased Grade 3/4 thrombocytopenia risk of 21% compared to 60% (3L: OR 1.16, p < 0.05; 4L+: OR 1.11, p < 0.05). For 4L+, physicians preferred a subcutaneously administered treatment (OR 1.10, p < 0.05). Mean importance of attributes relative to other attributes when selecting patient treatments. Conclusions: In assessing treatment preferences, HemOnc/Oncs placed higher relative importance on OS, PFS, ORR, and preferred a decreased risk of Grade 3/4 keratopathy and thrombocytopenia when choosing later line therapies for RRMM.[Table: see text]