Goldman, Erinn Hoag

PURPOSE This analysis aimed to contextualize the symptoms of peripheral neuropathy (PN) experienced by patients with triple-class refractory (TCR) multiple myeloma (MM) treated with elranatamab in the MagnetisMM-3 clinical trial with those experienced by patients with TCR MM receiving a new line of physician's choice of therapy in the real-world MagnetisMM-14 study. METHODS MagnetisMM-3 included 123 patients and MagnetisMM-14 included 35 who had TCR MM and were enrolled under the same eligibility criteria. Patient-reported symptoms of PN were collected monthly using the Chemotherapy-Induced Peripheral Neuropathy-20 item (CIPN20) questionnaire and compared for clinically meaningful differences across sensory, motor, and autonomic domains. Higher scores indicated worse patient-reported PN symptoms. RESULTS Baseline demographics and clinical characteristics for patients in MagnetisMM-3 and MagnetisMM-14 were generally similar. Patients in MagnetisMM-3 had a median of five ( v four in MagnetisMM-14) prior lines of therapy. In MagnetisMM-14, common index therapies included elotuzumab + pomalidomide (23%), carfilzomib + pomalidomide (19%), or carfilzomib + cyclophosphamide (19%), all with corticosteroids. Mean scores for sensory (15.8 v 14.8) and motor (14.4 v 12.2) domains of the CIPN20 were similar between MagnetisMM-3 and MagnetisMM-14 at baseline. Mean scores for the autonomic domain were 14.0 versus 21.3 at baseline, respectively. No clinically meaningful differences for any domain were found between month 6 scores or changes in scores from baseline to month 6 between MagnetisMM-3 and MagnetisMM-14 populations. CONCLUSION These findings suggest that elranatamab treatment was not associated with a worsening of patient-reported PN symptoms across the sensory, motor, and autonomic domains of the CIPN20. Moreover, PN symptoms reported with elranatamab treatment were similar to those reported with other common therapies used in real-world clinical practice for the management of MM. MagnetisMM-3 ClinicalTrials.gov identifier: NCT04649359 .

Introduction: Given the major treatment advancements in relapsed/refractory multiple myeloma (RRMM) such as bispecific antibodies (BsAbs), understanding patient and healthcare provider (HCP) decision-making perspectives is crucial. This study investigated barriers to adopting resource-intensive novel therapies, unmet needs in access to care, and treatment decision priorities in one of the largest surveys of RRMM patients and HCPs. Methods: This prospective study was conducted from March to June 2024 using 30-minute web-based quantitative surveys fielded in 2269 participants (1301 RRMM patients and 968 HCPs) across 7 countries (US, UK, France, Germany, Italy, Spain, Japan). The survey collected data on pre-defined patient subgroups (line of treatment, ages <45, 46-65, 65+]) and in HCP subgroups (care settings: academic, community [non-Center of Excellence [COE]). Data were analyzed using descriptive statistics and chi-square tests. Results: Two themes that emerged from the findings were: 1) discrepancies in treatment considerations between patients and HCPs, and 2) Familiarity with and considerations around BsAbs among patients Discrepancies in HCP and Patient considerations HCPs and patients prioritized different considerations during treatment decision-making, particularly related to the importance of treatment related adverse events (TRAEs). 3L+ patients equally prioritized disease control and minimizing TRAEs (49% and 49%); HCPs prioritized disease control more often than minimizing TRAEs (59% and 40% for 3L+ patients). Patients considered many TRAEs extremely challenging to manage, whereas HCPs were less likely to do so (patients vs HCPs: bone-related AEs: 64% vs 39%, p<0.001; hypertension: 54% vs 28%, p<0.001; cholesterol: 53% vs 21%, p<0.001; skin-related AEs: 49% vs 30%, p<0.001). Limiting TRAEs was a concern particularly among patients over 65 (52%, p<0.001) and those with comorbidities (52%, p<0.001). Limiting costs and financial challenges (3L+ patients: 33% vs HCPs: 13%, p<0.001) and avoiding compromising the potential to receive treatment options in later lines (3L+ patients: 25% vs HCPs:14%, p<0.001) were other considerations patients prioritized more than HCPs. HCPs prioritized limiting side effects 9% more in 3L settings compared to 2L. Discrepancies in decision-making in 2L setting included a desire to limit treatment-related logistical burden (patients: 35% vs HCP: 17%, p<0.001), limit challenges for care partners (25% vs 13%, p<0.001), and ensure treatment without referral (24% vs 16%, p=0.001). Compared to their older counterparts, younger patients (<45 y v ≥45y) prioritized convenient treatment administration (39% vs 29%, p=0.024) and avoiding referrals to other institutions (32% vs 22%, p<0.001). Perspectives on treatment considerations specific to BsAbs Among 3L+ patients, most have not heard of BsAbs, or have heard but were unfamiliar with the option. A small proportion of 3L+ patients recalled their HCPs suggesting BsAbs as a treatment option (14%) although most patients decided to receive BsAbs treatment when it was offered (71%). Among patients on BsAb treatment, patients most often cited clinical reasons for going on BsAbs (i.e., remission, symptom relief, and likelihood of greater longevity). Among non-clinical reasons, lower time commitment and lower likelihood of negative financial impact compared with other treatments were also common. Notably, 36% of HCPs reported low confidence in identifying RRMM patients eligible for BsAbs. Compared with academic HCPs (32%), more community/non-COE HCPs (42% p=0.018) reported low confidence. Conclusions: HCPs and patients have different priorities during treatment decision-making, particularly regarding the importance of minimizing TRAE and in prioritizing efficacy and managing logistical burdens in later treatment lines. Among novel treatments, BsAbs are not frequently recalled by patients as a treatment option provided by HCPs. HCPs, especially in community settings, are often uncertain about identifying eligible patients for BsAbs, indicating a need for greater educational resources for HCPs. Increasing patient awareness of available treatments, HCP understanding of novel treatments, and fostering dialogue on patient priorities can increase the likelihood of informed, personalized shared decision-making, and optimize evidence-based patient outcomes.