Multiple Myeloma (MM) is the second most common hematologic malignancy. It accounts for 2% of the cancer related deaths in the United States (US) and 1% worldwide. Fortunately, in the past two decades, the Food and Drug Administration (FDA) has approved several new agents which can be sequenced to treat MM patients in the US. Also, there has been intensification of frontline therapy in eligible patients. The aim of this study is to review if MM specific mortality trends have changed with these treatment changes.
Using population data from Surveillance, Epidemiology, and End Results (SEER), we reviewed age adjusted Myeloma Mortality Rate trend from 1975 to 2019 in the US population. The Annual Percent Change (APC) with p-value has been reported. The reported APC has been calculated using the Joinpoint Trend Analysis Software, Version 4.9, March 2021, National Cancer Institute.
The MM mortality was increased during 1975-1993 (APC 1.49%; p<0.01). It was decreased during 1993-2002 (APC -0.49%; p<0.01), 2002-2009 (APC -2.00%; p<0.01) and 2012-2019 (APC -1.61%; p<0.01). No statistically significant change was seen during 2009-2012 (APC 1.29 %; p = 0.38).
This retrospective US population data review shows decreasing MM specific mortality in the US population since mid-1990’s correlating with the intensification of frontline treatment and expansion of available treatment options. There was an increase in MM mortality from 1975-1993 and no major treatment changes occurred during this period. After routine use of ASCT in frontline in mid-1990’s, slight decrease in mortality trend during 1993-2002 was seen. Significant reduction in MM mortality was seen during 2002-2009 when proteasome inhibitors and immunomodulatory drugs were approved. With approval of more agents including monoclonal antibodies since 2012, routine use of frontline triplet therapy and maintenance therapy since mid-2010’s, the significant decrease in mortality trend continued during 2012-2019. Since then, more drugs including novel agents have been approved and risk stratification guided treatment paradigm is evolving. Changing treatment landscape seems to be correlating with changing epidemiology of MM.
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D.M. Hamouda: Financial Interests, Institutional, Invited Speaker, A Phase 2b, Open-label, Multicenter, Randomized Parallel-Group, Two-Stage, Study of an Immunotherapeutic Treatment DPX-Survivac, Alone or in Combination with Pembrolizumab, with and without intermittent Low-Dose Cyclophosphamide, in Subjects with Relapsed/Refractory Diffuse Large B-Cell Lymphoma. NCT04920617. Period: 10/15/2020 - ongoing. Role: Principal InvestigatorSponsor: Immunovaccine Technologies, Inc.: Immunovaccine Technologies, INC; Financial Interests, Institutional, Invited Speaker, A Phase I/II Dose Escalation Study with Expansion Cohort to Investigate the Safety, Biologic and Anti-tumor Activity of ONCOS-102 in Combination with Durvalumab in Subjects with Advanced Peritoneal Malignancies. NCT02963831. Period: 9/11/2018 – 10/8/2020.Role: Principal InvestigatorSponsor: Ludwig Institute for Cancer ResearchA Phase I/II Study of in Situ Vaccination with Tremelimumab and IV Durvalumab (MEDI4736) Plus the Toll-like Receptor Agonist PolyICLC in Subjects with Advanced, Measurable, Biopsy-accessible Cancers. NCT02643303. Period: 5/23/2019 – 6/3/2021.Role: Principal InvestigatorSponsor: Ludwig Institute for Cancer Research: Ludwig Institute for Cancer Research; Financial Interests, Institutional, Invited Speaker, An open-label, multi-center, phase IB/II study to evaluate the safety and efficacy of Copanlisib in combination with Nivolumab in patients with advanced solid tumors. NCT03735628. Period: 9/5/2019 – 4/1/2021. Role: Principal Investigator Sponsor: Bayer: Bayer. All other authors have declared no conflicts of interest.