Combination treatments including novel proteasome inhibitors (PIs) provide more options for patients with relapsed/refractory multiple myeloma (R/R MM), and a study published in Patient Preference and Adherence examined treatment preferences.

Preferences among combinations of 4 treatment attributes were assessed in 84 adults with R/R MM. These included treatment regimen, duration of time without disease progression, and possibilities of grade 3 or higher adverse events (AEs) involving either the blood or heart failure.

Therapy application regimens included once-daily oral intake and the following 3 options: additional once-weekly oral intake with 1 monthly physician visit, additional twice-weekly oral intake with 1 monthly physician visit, or additional once-weekly oral intake with twice-weekly physician visits featuring intravenous infusions.

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Duration without disease progression included options of 17, 20, or 26 months. Hematologic grade 3 or higher AE probabilities included 12 vs 19 of 100 patients. Grade 3 or higher AE-related heart failure probabilities included 2 vs 4 of 100 patients.

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Patients ranked attributes in the following order of importance: treatment application regimen (38.8%), duration without disease progression (38.7%), possibility of heart failure as an AE (13.9%), and possibility of hematologic AE (8.6%).

Once-daily plus once-weekly exclusively oral therapy was the preferred administration, and patients preferred longer times without disease progression as well as lower risks of adverse events. However, many were willing to limit progression-free time for all-oral therapy and lower risk of AEs.

Matching these preferences to attributes of existing combination treatments showed lenalidomide with dexamethasone plus ixazomib ranked highest, lenalidomide with dexamethasone without a PI ranked second, and lenalidomide with dexamethasone plus carfilzomib ranked third.

The study authors suggest that patient preference should be investigated when determining which treatment option to use for patients with R/R MM. These results illustrated a preference for exclusively oral therapy, along with longer progression-free time, and lower AE risk. However, if in a trade-off situation, all-oral application is preferred over progression-free time.


Wilke T, Mueller S, Bauer S, et al. Treatment of relapsed refractory multiple myeloma: which new PI-based combination treatments do patients prefer? Patient Prefer Adherence. 2018;12:2387-2396.