HCPs generally prioritized efficacy and quality of life, while patient goals were more varied1,2

To assess RRMM treatment goals, the survey asked patients and HCPs to select their top 3 priorities when starting a new treatment1,2

aEarly-stage RRMM defined as 1 prior line of therapy. Later-stage RRMM defined as 2 or more prior lines of therapy. bGraph shows the percentage of patients with early-stage RRMM and HCPs who selected these responses among their top 3 priorities.1 cLanguage of some responses has been simplified from survey prompt. dGraph shows the percentage of patients with later-stage RRMM and HCPs who selected these responses among their top 3 priorities.1

HCP, health care professional; RRMM, relapsed/refractory multiple myeloma.

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Younger patients (aged less than 65 years) prioritized convenient treatment administratione and avoiding referrals1,f
Older patients (aged 65+ years) prioritized limiting disease progression and side effects1
eRefers to how patients take their treatments or the timing required for them (including travel, time receiving treatment, and any follow-up visits). fSuch as prioritizing treatments readily available in their HCP’s practice. gDefined as treatment goals chosen as a top 3 treatment priority by more patients less than 65 years old compared with their older counterparts, with a difference of at least 10% between the groups. hDefined as treatment goals chosen as a top 3 treatment priority by more patients 65+ years old than their younger counterparts, with a difference of at least 10% between the groups.
Priorities for Patients With Comorbidities
Patients with comorbidities, regardless of age, were more likely to prioritize limiting treatment-related side effects than their counterparts (52% vs 32%; P=.055)1
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Older patients with RRMM were more likely to find aspects of their treatment to be “worse” or “slightly worse” than expected1

Aspects of MM Treatment Found to Be Worse or Slightly Worse Than Expectations by Age1

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MM, multiple myeloma.
Patients with later-stage RRMM were less likely to report care meeting their expectations vs patients with early-stage RRMM1
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Steering Committee Recommendations on Positive Steps for the MM Community to Consider
CALL TO ACTION

Support increased access to support services, such as social workers, counselors, gerontologists, and patient navigators, and identify opportunities to reduce treatment-related financial burdens

Who Can Take Action?

Patient advocacy groups, payers, policymakers, industry

Rationale

This survey found that patients experience a variety of treatment-related burdens, including side effects, psychological challenges, logistical difficulties, and financial challenges.1

Increasing access to support services may help alleviate many of these treatment-related burdens. For instance, counselors can help navigate the impact of care on mental health, while gerontologists can help provide care that addresses the specific needs of elderly patients.3 Non-clinical support staff, such as patient navigators and social workers, may help patients access resources that address logistic and cost considerations.4 Increasing the financial resources for patients, and better communicating the available resources, may also help ease treatment-related financial burdens.4-6

Support studies to investigate if dosing regimens can be made more convenient for patients without compromising efficacy

Who Can Take Action?

Researchers, HCPs, industry

Rationale

Changes to dosing regimens, such as reducing how often treatments need to be taken and including breaks from treatment in responding patients, can increase convenience for patients.7,8 These changes may also reduce side effects and financial challenges, easing many patient burdens.8,9

Develop discussion tools in partnership with patient advocacy groups to help foster a more cohesive dialogue between patients and HCPs

Who Can Take Action?

Researchers, HCPs, patients, patient advocacy groups

Rationale

Survey findings indicate treatment goals differ between patients and HCPs.1 Additionally, treatment goals and patient perceptions are impacted by many factors, including age, the presence of comorbidities, and the number of times the patient has relapsed.1 Developing and using shared decision-making tools may help ensure patients are receiving the care that best aligns with their unique treatment goals.10-12

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Patients and HCPs considered different side effects to be challenging to manage1
  • Patients tended to consider more side effects to be “extremely challenging” to manage, including those not typically managed by hematologists/oncologists1,13
  • Survey findings suggest a gap in managing side effects that are potentially addressed by non-hematologists/ oncologists1,13
  • The few side effects that more HCPs than patients considered “extremely challenging” were those associated with recently approved immunotherapies (eg, cytokine release syndrome [CRS] and immune effector cell–associated neurotoxicity syndrome [ICANS])1,15,16,l,m
  • HCPs may be less familiar with managing the side effects associated with recently approved immunotherapies (eg, bispecific antibodies [BsAbs] and chimeric antigen receptor [CAR] T cells)1,15,17,18
iGraph shows side effects considered “extremely challenging” by at least 10% more patients than HCPs. jP value was not reported. kOnly patients who had experienced a specific side effect were asked how challenging it is to manage. lIncludes side effects considered “extremely challenging” by at least 10% more HCPs than patients. mSide effects considered “extremely challenging” by both HCPs and patients included leukemia and serious infections (data not shown).1
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Steering Committee Recommendations on Positive Steps for the MM Community to Consider
CALL TO ACTION

Reduce Treatment Burden by Using a Comprehensive Approach to Manage Side Effects

Support a proactive approach to patient and care partner education to help manage side effects

Who Can Take Action?

HCPs, patients, care partners

Rationale

Patients and care partners may not be fully aware of actions they can take to prevent or lessen the impact of side effects. Providing education on practical matters ranging from fall prevention measures and safe exercises to use of moisturizers can help to reduce the risk of certain side effects and empower patients to take control of their health.19-21 Additionally, educating patients to notify their care team members of health events as they occur may also help to manage side effects more effectively.12

Support HCP education and coordination of care for optimal management of side effects

Who Can Take Action?

Clinical experts, HCPs

Rationale

The survey findings indicate patients may need additional support to manage side effects.1 Recommended supportive or prophylactic measures may be underutilized in patients with MM,22 and care may be fragmented between oncologists and other providers, such as primary care physicians, particularly for patients with comorbidities.13,23 Peer-to-peer education and sharing of best practices may help improve these areas to potentially provide better supportive care. The efforts should include all care team members, such as nurses and pharmacists who regularly interact with patients and therefore are well-positioned to identify potential side effects or issues with following the treatment plan.24,25

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  • There is an opportunity to improve patient awareness of BsAbsn and CAR T-cell therapies1

When asked about recently approved immunotherapies

  • Up to 42% of patients had never heard of BsAbs1,n
  • Up to 33% had never heard of CAR T-cell therapies1
  • Patient awareness was highest in the US and lowest in the EU and Japan1,o

nIncludes B-cell maturation antigen-directed or G protein–coupled receptor class C group 5 member D-directed BsAbs.1

oAt the time of the survey (March–June 2024), CAR T-cell therapies were not available in the UK and BsAbs were not available in Japan.1

CAR-T, chimeric antigen receptor T-cell therapies.

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  • Few patients recalled physicians offering BsAbs or CAR T-cell therapies1,p
The survey did not capture treatment eligibility. However, only a small proportion of patients remembered their HCP offering these immunotherapies as options.1 This suggests that for patients who know at least some information about these therapies, awareness may be driven by their own research rather than conversations with the care team.
  • Data revealed disparities in awareness of the therapies between White and non-White patients in the US1,q
  • Awareness of the therapies was lower in underserved (non-White) populations in the US1
  • Non-White patients in the US were also less likely to report being treated by a doctor who specializes in MM1
pAt the time of the survey (March–June 2024), CAR T-cell therapies were not available in the UK and BsAbs were not available in Japan.1 Note that patients who reported they had never heard of these therapies were not asked if their physician had discussed or offered these therapies. qThe only country for which racial data were available was the US.1
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Learn how BsAbs and CAR T-cell therapies work

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Efficacy was the most important consideration for patients who chose BsAbs or CAR T-cell therapies1

  • Of patients who were offered BsAbs, 57% (n=51) chose to receive treatment1,26
  • Convenience and physician recommendation were also among top reasons patients chose BsAbs1

  • Of patients who were offered CAR T-cell therapies, 76% (n=103) received treatment1,26
  • Learning that CAR T-cell therapies worked well for others was one of the top reasons for choosing the therapies, suggesting demand for CAR T-cell therapies may be influenced by other patients’ experiences1

rSurvey respondents could select up to 5 responses from a choice of 15.27 sSurvey respondents could select up to 5 responses from a choice of 13.27

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The top reason patients declined BsAbs or CAR T-cell therapy was due to feeling overwhelmed1

Reasons for patients declining treatment as reported by HCPs were generally similar between the 2 therapies, yet1:

tIn the survey sample, 11 patients each declined BsAbs or CAR T-cell therapies. Due to this small number of patients, patient data on their reasons for declining therapies were not included. HCPs were asked to choose the top 5 reasons their patients declined each type of therapy from a selection of 15.1,28
AE, adverse event; MM, multiple myeloma.

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Steering Committee Recommendations on Positive Steps for the MM Community to Consider
CALL TO ACTION

Improve Patient Familiarity with Recently Approved Immunotherapies

Partner with patient advocacy groups to increase awareness of BsAbs and CAR T-cell therapies, particularly among patients in underserved populations

Who Can Take Action?

HCPs, patients, patient advocacy groups, industry

Rationale

The limited awareness among patients with RRMM (up to 42% of patients had never heard of BsAbs, and up to 33% had never heard of CAR T-cell therapies) indicates a need for broad patient education.1 Awareness was lowest in the EU and Japan, and among non-White patients in the US, suggesting educational efforts may be particularly needed for these groups.1 Patient advocacy groups and other organizations can be important sources of patient information and improve awareness through educational outreach, helping to ensure patients are fully informed when making treatment decisions.29 In addition, survey results suggest that including platforms for patient-to-patient communication may be particularly impactful.1

Support creation and distribution of information to make patients and care partners more comfortable receiving these types of immunotherapies

Who Can Take Action?

Clinical expert, HCPs, patient advocacy groups

Rationale

For both bispecific antibodies and CAR T-cell therapies, feeling overwhelmed was the top reason patients declined treatment.1 Providing practical advice through multiple methods of communication (verbal, written, and video content, patient mentors, etc) may help reduce complexity for patients.

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Recently approved immunotherapies may not be offered to all eligible patients1

HCPs did not offer BsAbs or CAR T-Cell therapies to all patients they considered to be eligible1
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Awareness of recently approved immunotherapies was lower in non-White populations in the US1,u

uThe only country for which racial data were available was the US. The data represent results from all patient respondents from the US regardless of eligibility for BsAbs or CAR T-cell therapies. Eligibility for BsAbs or CAR T-cell therapy was not determined in the survey.1

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Perceived logistical challenges may prevent HCPs from offering immunotherapies to eligible patients1

  • In addition to logistical challenges, limited administration capacity was another top reason for not offering both BsAbs and CAR T-cell therapies to patients1
  • For both therapies, patient financial challenges were more of a concern for HCPs in the US vs other regions1,v

  • Other reasons HCPs did not offer BsAbs included1:
    • Patients’ ability to monitor side effects, safety risk perceptions, and need for more education and experience with BsAbs
  • CAR T-cell therapy–specific concerns included1:
    • Treatment start delays, lack of in-practice administration capabilities, referral needs

vFor BsAbs, 36% of US HCPs cited patient financial concerns as a reason to not offer therapy, compared with 14% of EU HCPs. For CAR T-cell therapies, 42% of US HCPs cited financial concerns compared with 18% of EU and 21% of Japanese HCPs.1 wSample consisted of HCPs from US and Europe but not Japan.1 xSimplified from survey language.

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There is an opportunity to improve physician confidence in identifying eligible patients for BsAbs and CAR T-cell therapies1
HCPs at both types of institutions were more confident in identifying patients eligible for BsAbs than for CAR T-cell therapies1
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Steering Committee Recommendations on Positive Steps for the MM Community to Consider
CALL TO ACTION

Increase HCP Familiarity With Recently Approved Immunotherapies

Support physician-led programs providing peer-to-peer education and collection of real-world evidence around immunotherapies while promoting collaboration between oncologists at academic centers/COEs and those in community clinics/non-COEs

Who Can Take Action?

Clinical experts, HCPs, industry

Rationale

HCPs in community clinics were significantly less confident in their ability to identify eligible patients for recently approved immunotherapies than their counterparts at academic/COE institutions, suggesting a knowledge gap between these groups.1 Without confidence in identifying eligible patients, HCPs may be hesitant to adopt these therapies into their routine clinical practice. Programs that connect clinical experts with community HCPs to share best practices may improve physician confidence in identifying eligible patients and using these therapies.18 Additionally, real-world data around patient outcomes, particularly in patients who might not have qualified for clinical trials, may bolster clinical evidence and address the safety concerns of HCPs regarding these therapies.18

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Steering Committee Recommendations on Positive Steps for the MM Community to Consider
CALL TO ACTION

Reduce Barriers to the Adoption of Recently Approved Immunotherapies

Explore opportunities to help reduce the challenges associated with administration of recently approved immunotherapies

Who Can Take Action?

Clinical experts, industry

Rationale

Logistical challenges and hospitalization for side effect monitoring were among the top reasons that HCPs did not offer immunotherapies and patients declined them, respectively.1

To address these issues, real-world studies have begun to investigate the feasibility and safety of initiating these therapies in an outpatient setting,30,31 which may improve accessibility of these treatments for both patients and HCPs.15,18 Additionally, reducing the time patients spend in a hospital may help relieve capacity and resource limitations, addressing a concern of HCPs regarding these therapies.30

Explore reasons for differences in patient access to recently approved immunotherapies and potential solutions to address those gaps

Who Can Take Action?

Clinical experts, patient advocacy groups, policymakers

Rationale

Non-White patients were less likely to recall being offered recently approved immunotherapies than their White counterparts.1 This echoes findings from other studies, which have found disparities in access to MM treatments and outcomes among patients of different races and socioeconomic status (SES).15,29 Non-White patients were also less likely to be treated by MM specialists.1 Such outcomes support continued research into why racial and SES factors affect access to MM treatment, including recently approved immunotherapies.

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Watch Dr Rakesh Popat highlight the Unite for MM initiative

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Access the survey publication to deepen your understanding of key insights

Learn more

Review summary of challenges faced by the RRMM community and potential actions to improve MM care

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References

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