Patients with multiple myeloma who had lower physical function scores at the time of treatment initiation demonstrated a greater benefit to daratumumab treatment than those with higher physical function scores, according to the results of a study published in the European Journal of Haematology. These patients showed a greater benefit in terms of both progression-free and overall survival.
“The responses revealed that patients with lower scores benefited more from daratumumab, lived longer, and had a lower risk of disease progression,” stated lead author Ahmad Y. Abuhelwa, PhD, Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, United Arab Emirates. “This is the first study to demonstrate that patient-reported physical function at treatment initiation can predict which patients derive the greatest survival benefit from daratumumab, a monoclonal antibody widely used in the treatment of multiple myeloma.”
Study Methods and Results
Researchers analyzed patient-reported outcome questionnaires from three randomized trials of patients with multiple myeloma that received daratumumab-based therapies in the investigational arms: MAIA, POLLUX, and CASTOR. A total of 1,535 pretreatment patient-reported outcomes were available across the three trials.
The researchers were looking to see if physical function compared with ECOG performance status could be a treatment effect modifier between the treatment options.
Physical function demonstrated independent prognostic value separate from ECOG performance status. Physical function was also predictive of treatment effect with daratumumab-based therapies.
“How well cancer patients can perform daily tasks like walking or getting dressed is a powerful predictor of survival outcomes and treatment benefit in people with multiple myeloma receiving daratumumab-based therapies,” stated Dr. Abuhelwa.
In patients with low physical function who received daratumumab-based therapies, the risk of death was reduced by 47% (hazard ratio [HR] for overall survival = 0.53; 95% confidence interval [CI] = 0.40–0.70; P < .001), and the risk of disease progression was reduced by 66% (HR = 0.34; 95% CI = 0.22–0.53; P < .001), compared with patients who did not receive daratumumab.
Among the patients with higher physical function at baseline, daratumumab-based treatments led to a 14% reduction in the risk of death (HR = 0.86; 95% CI = 0.62–1.19; P = .364) and a 47% reduction in the risk of disease progression (HR = 0.53; 95% CI = 0.42–0.67; P = .034).
“Patient-reported scores gave a more accurate and sensitive prediction of survival and treatment effect. This highlights a critical gap—ECOG alone may not capture the full picture. We need to start listening to patients,” Dr. Abuhelwa stated. “With further validation, patient-reported outcomes could become an essential part of personalized treatment strategies, ultimately improving both survival and quality of life for people living with multiple myeloma.”
The study authors noted that their study adds to a growing body of work showing that patient-reported outcome assessments should be integrated more into oncology to improve symptom management, quality of life, and survival outcomes. They noted that further study is needed to see how physical function as a predictor of survival extends to use of other myeloma treatments.
Disclosure: For full disclosures of the study authors, visit onlinelibrary.wiley.com.
