Financial Burden, Treatment Efficacy and Safety in Multiple Myeloma

Saad Usmani, MD, MBA, FACP, chief of myeloma service, Memorial Sloan Kettering Cancer Center, discusses current challenges in treating multiple myeloma, financial burdens associated with this type of cancer, and where the future of care may be headed.

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Welcome back to PopHealth Perspectives, a conversation with the Population Health Learning Network where we combine expert commentary and exclusive insight into key issues in population health management and more.

Today, we are joined by Dr Saad Usmani, chief of myeloma service at Memorial Sloan Kettering Cancer Center in New York City. He discusses current challenges in treating multiple myeloma, financial burdens associated with this type of cancer, and where the future of care may be headed. Dr Usmani?

Hi. My name is Dr Usmani. I'm the chief of the myeloma service at Memorial Sloan Kettering Cancer Center in New York City.

Can you briefly discuss some challenges associated with treating multiple myeloma?

Multiple myeloma is considered an incurable disease. Even though we have come a long way in terms of improving survival outcomes in the past 15-20 years, it's still a relapsing, remitting kind of a disease for the most part. As patients get into late relapses, that's when managing them becomes challenging.

Even though we have come a long way in improving survival outcomes of myeloma patients over the past two decades—we've improved survival from about 2-3 years to well over 9-10 years at an average—I think the challenges we face right now is picking the right treatment at each step of the way for our patients.

Myeloma is still considered an incurable disease and we know that not all patients get all the drugs if treated sequentially, because patients do succumb to the sequel of the disease.

The challenge is, how do you pick the right treatments at the right time during the course of their journey, essentially.

What would you say are the financial burdens on the industry associated with this type of cancer?

Cancer care in general is not cheap. There are many facets to the burden that cancer care places on the health care system or that whole complex, whether it is on the pharma end of things in terms of drug discovery and clinical development of drugs, to provision of health care and how that ties into the private insurers, or federally, or state-supported insurers.

If you look at that whole burden, there's a big financial burden on the health care system.

It's also very important to appreciate the financial toxicity it creates for our patients that we are caring for. There is strong data in literature to highlight the financial impact on patients and how many patients actually end up becoming bankrupt because of the cost that they have to incur.

When we're talking about new therapies, we’ve always talked about the safety and efficacy of treatments and their impact on longevity or outcomes. We also have to understand the financial toxicity and side effects it places on the lives of our patients.

You mentioned briefly the challenges associated with picking different types of treatments. Under what circumstances do providers typically opt for treatment with Darzalex?

Daratumumab is the first monoclonal antibody that was approved for multiple myeloma as a disease about six years ago and has changed the management of myeloma in so many ways. It's an easier therapy to give amongst the armamentarium of drugs we have and partners well with other mechanisms of actions.

It's been an important part of improving the survival outcomes for our patients. Over the course of its development, it's gone from being a long IV infusion to an under-the-skin shot that's given under five minutes. From a convenience standpoint and efficacy standpoint, it has changed the outcomes for our patients and their quality of life.

In terms of efficacy, safety, and cost, things of that nature, how does daratumumab compare with other therapies on the market?

In terms of cost, daratumumab is similar in cost when you think about comparable therapies. There are other monoclonal antibodies that target both CD38 as well as IMF7 .

With the outcomes that we've seen with daratumumab-based combinations, there have been several publications that highlight the comparative effectiveness of daratumumab-based combinations in reference to QALY and have found daratumumab to be effective from that perspective, compared to some of the other therapies that have been previously utilized for myeloma.

I think one of the reasons is because of its efficacy as well as safety profile, it's an easier therapy to give compared to some of the other therapies out there for the refractory patients in the relapse setting and then in the front-line setting too, given its side effect profile appears to be better than some of the other therapies.

As the treatment landscape continues to evolve, and there have been recent developments in recent years, where do you see the future of multiple myeloma care going?

We are starting to recognize that myeloma is not one disease and we need to probably split it into certain biologic categories. We also have to think about treating older, more frail patients a bit different than the relatively younger or intermediate-fit patients.

What we're also recognizing is that the response during that first year of diagnosis is important. Designing strategies and regimens to get each of these categories of patients through that depth of response and to sustain it is becoming an important goal of treatment.

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