Multiple myeloma is a disease of age. With all of the new myeloma drugs being developed, there are number of treatment options for relapsed and refractory multiple myeloma (RRMM). However, in our knowledge, few data are available in patients older than 65 or 75 years. We performed a meta-analysis to compare the efficacy of new drugs to treat RRMM between younger and older patients.
PubMed and the Cochrane databases were searched up to April 2016. We included phases III randomized controlled trials (RCTs) of monoclonal antibodies (mAbs) targeting CD38 or SLAMF7 (daratumumab, elotuzumab), second generation proteasome inhibitors (carfilzomib, ixazomib) and histone deacetylase (HDAC) inhibitors (vorinostat, panobinostat) reporting subgroups comparison of progression-free survival (PFS) based of aged cut-offs. The summary hazard ratio (HR) and 95% confidential interval (CI) were calculated.
A total of 5241 patients from eight RCTs of RRMM new therapies were included (CASTOR, POLLUX, ELOQUENT-2, ASPIRE, ENDEAVOR, TOURMALINE-MM1, PANORAMA-1 and VANTAGE-088). When patients are dichotomized into younger and older groups with an age cut-off of 65-75 years, RRMM new therapies improved PFS in both younger (HR, 0.62; 95% CI, 0.56–0.70) and older (HR, 0.67; 95% CI, 0.60–0.74) groups. An improvement in PFS with mAbs was observed in younger (HR, 0.57; 95% CI, 0.46–0.72) and older (HR, 0.52; 95% CI, 0.42–0.64) patients. An improvement in PFS with HDAC inhibitors was also observed in both younger (HR, 0.67; 95% CI, 0.56–0.80) and older (HR, 0.78; 95% CI, 0.63–0.97) as well as with second generation proteasome inhibitors (HR, 0.61; 95% CI, 0.52–0.73 and HR, 0.70; 95% CI, 0.60–0.81 respectively).
A benefit in PFS with new therapies was significant in both younger and older patients with relapsed and refractory multiple myeloma with a cut-off age of 65–75 years.
Clinical trial identification
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All authors have declared no conflicts of interest.