From July 26 to July 28, 2024, the 8th Hematological Oncology Conference of the Chinese Society of Clinical Oncology (CSCO) was held in Harbin. During the conference, the "2023 Blue Book on the Status of Diagnosis and Treatment of Multiple Myeloma in China and the Quality of Life of Patients" (hereinafter referred to as the "Blue Book") led by the Blood Disease Hospital of the Chinese Academy of Medical Sciences was released. By conducting large-scale doctor-patient surveys across the country, the Blue Book explores the disease burden, unmet needs, quality of life, clinical diagnosis and treatment mode and impact of diseases in clinical practice of real-world patients, brings a new perspective of the real world to the improvement of disease awareness and the construction of standardized diagnosis and treatment pathways for multiple myeloma in mainland China, and leads the overall improvement of the diagnosis and treatment level of multiple myeloma.
Multiple myeloma (Multiple Myeloma) is the second most common malignant tumor in the blood system, with an incidence of about 1.6 per 100,000 in mainland China, often manifested as bone damage, anemia, hypercalcemia, kidney damage, etc., and mostly occurs in the elderly. Since multiple myeloma is still an incurable malignant hematological malignancy, patients will eventually face the dilemma of recurrence. The greater the number of clinical recurrences, the more difficult it is to treat, and the shorter the progression-free survival and survival time after recurrence. In the context of the Chinese mainland is about to enter a moderately aging society, patients urgently need more innovative and high-quality drugs and solutions.
Professor Wang Jianxiang, chief clinical expert of the Blood Disease Hospital of the Chinese Academy of Medical Sciences, said: "Under the trend of Chinese population aging, multiple myeloma has become an increasingly important aging health issue. Due to the relapse dilemma faced by patients, there are still many challenges in physical and mental health and quality of life in existing therapies. Therefore, we hope to understand the unmet needs of patients and doctors through systematic research on the real treatment status and clinical diagnosis and treatment mode of patients, further drive the construction of a standardized diagnosis and treatment system, and provide a basis for the application of more innovative drugs and innovative therapies in the future. Taking multiple myeloma as the entry point, it responds to the strategic initiative of healthy aging, and also contributes to the goal of the overall 5-year survival rate of cancer in 2030 by Healthy China. ”
Patients with multiple myeloma face a heavy burden, and both doctors and patients are looking forward to the accelerated introduction of more innovative therapies
With the intensification of aging in mainland China, the incidence of multiple myeloma is also increasing year by year, but there are still many patients who are missed or misdiagnosed. According to the Blue Book, only 5% of patients go to the haematology department at the first sign of symptoms, and only 58% of patients are diagnosed with multiple myeloma for the first time.
For patients entering the treatment phase, they also face challenges in terms of physical and mental health and quality of life. Among the 450 patients with multiple myeloma surveyed, the utility value of EQ-5D-5L (European Five-Dimensional Five-Level Quality of Life Scale) was only 0.85, which was much lower than that of the healthy population in China (0.96). Forty-three percent of patients had limited mobility, 33 percent had difficulty caring for themselves, 41 percent had limited daily activities, 72 percent had experienced pain or discomfort, and 65 percent had experienced anxiety or depression.
The mental health of patients is also greatly affected by the disease, with more than half (53%) of patients having experienced depression, anxiety or hopelessness, and about six out of ten (59%) having been troubled by feelings of tension and anxiety. At the same time, illness also places a burden on caregivers and families as a whole, with nearly half of patients (48%) having varying degrees of absenteeism due to caring for patients. Fifty-seven per cent of these caregivers were absent from work for more than 20 days due to illness to care for patients.
The Blue Book survey also showed that patients had a large unmet need for existing treatments, with an overall satisfaction score of only 61.7. "Expecting a treatment with better efficacy or the emergence of a specific drug" ranks among the top two unmet needs and expectations of patients. Among them, 45% of patients said that drug accessibility is low and the degree of convenience is low, calling for accelerating drug research and development and innovative therapies into medical insurance in the future to improve drug access. At the same time, 69% of doctors also believe that improving the effectiveness of treatment plans is an urgent problem to be solved in the future, ranking first in the "problems that doctors need to solve". Prolonging life (86%), halting disease progression (80%), and reducing disease symptoms (61%) were considered the three most important aspects of treatment options.
Professor Qiu Lugui, Chief Physician of the Hematology Hospital, Institute of Hematology, Chinese Academy of Medical Sciences, pointed out: "The overall satisfaction of patients in the survey was lower than that of doctors, indicating that there are cognitive differences between doctors and patients, and patients have higher expectations for treatment outcomes and quality of life. Due to the characteristics of multiple myeloma that are easy to recur and refractory to treatment, patients urgently need more innovative treatments. Therefore, it is imperative to accelerate the introduction and accessibility of innovative therapies, and it is necessary to make more patients with multiple myeloma have drugs available and innovative drugs available, so as to achieve less recurrence and longer survival. ”
Grasp the golden window of early treatment and prolong the progression-free survival of patients
According to the Blue Book, the treatment of multiple myeloma has different treatment considerations at different stages, and the patient's age, comorbidities, and previous treatment options are important decision-making factors for doctors when choosing a treatment plan for a patient. However, the core goal is to help patients achieve maximum remission, improve quality of life, and prolong progression-free survival (PFS).
Multiple myeloma is a cost-effective cancer for early treatment, and the "golden window period" of initial diagnosis and first recurrence is particularly critical in clinical practice. For patients with newly diagnosed multiple myeloma, RVd (lenalidomide/bortezomib/dexamethasone) has become the primary treatment regimen unanimously recommended by domestic and foreign guidelines. According to the Blue Book, on average, 74 percent of patients are given RVd triple therapy as a first-line induction regimen, and another 85 percent of physicians say that patients who require consolidation therapy are treated the same as induction therapy.
At the United States Society of Clinical Oncology (ASCO) annual meeting just concluded in June, new advances were made in the first-line therapy of multiple myeloma. In the published IMROZ Phase 3 clinical data, the combination of Isatuximab, a next-generation CD38 monoclonal antibody, in combination with RVd and maintenance therapy with Isatuximab-Rd, significantly reduced the risk of recurrence or death by 40% in patients with newly diagnosed multiple myeloma who are not transplantable compared to standard treatment with lenalidomide, bortezomib and dexamethasone (RVd) and maintenance therapy with Rd. Approximately three-quarters (74.7%) of patients treated with Isatuximab-RVd achieved a complete response (CR) and more than half (55.5%) achieved a complete response that was negative for minimal residual disease (MRD).
Professor Qiu Lugui said: "The fight against multiple myeloma is a long-term battle and a 'race to the bottom', and if deep remission and longer PFS can be achieved at the early stage or even first-line treatment, we can better meet the expectations of patients to prolong their lives and stop the progression of the disease." The results of the combination of Isatuximab and RVd at the ASCO Annual Meeting bring new confidence to first-line treatment and are expected to redefine standard therapy based on RVd. With the introduction of more innovative therapies in China, it is expected that more Chinese patients will move towards 'functional cure' and truly realize the chronic management of cancer." ”