Racial Disparities Persist in Multiple Myeloma Treatment

Racial disparities persist in the treatment of patients with multiple myeloma (MM), reinforcing the need to mitigate treatment barriers in this population, according to a recent study published in Cancer Medicine.

It has been established and documented that there are racial disparities that impact the treatment of MM, particularly in the non-Hispanic African American (NHAA) community which has demonstrated to be twice as vulnerable to developing and dying from MM compared with non-Hispanic White (NHW) patients.

Multiple Myeloma on Tablet Screen | image credit: ibreakstock - stock.adobe.com

As the authors of the present study note, the treatment landscape for MM has dramatically improved in the last decades, and chemotherapy is no longer a patient’s only option. Additional therapies such as proteasome inhibitors, immunomodulatory medications, monoclonal antibodies, chimeric antigen receptor T-cell therapy and more have become available.

While these treatments have improved the 5-year survival of patients with MM in the US by an increased 23% since 2000, prior research indicates that these survival rates vary according to race. To provide more comprehensive data on these treatment patterns, researchers conducted a real-world study to investigate racial differences in the timing of treatment initiation, receipt of treatment, and survival of older Medicare beneficiaries with MM.

Data were gathered from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify NHAA and NHW patients (aged 66 years and over) with MM who were diagnosed between 2007 and 2017. Information on patient treatment was tracked within 1 year following their diagnosis.

In total, 2094 NHAA and 11,983 older patients with MM were included. These group received treatment in their first year at rates of 59.5% and 64.8%, respectively (P < .01). In 2007, the discrepancies between the two groups stood at 2.9%. In the period between 2014 and 2017, this disparity rose to 6.9%.

Once researchers controlled for relevant factors, they confirmed further that the initiation of treatment was significantly longer in NHAA patients compared with NHW patients (HR, 0.91; 95% CI, 0.85-0.97; P < 0.01).

Further results demonstrated that NHAA patients experienced a shorter median survival rate than NHW patients (1.97 years [95% CI, 1.78-2.17] vs 2.37 years [95% CI, 2.26-2.44]; P < .01). Additionally, those patients who were treated in the year following their diagnosis experienced a longer median survival than those who did not receive treatment in the first subsequent year (2.74 years [95% CI, 2.65-2.85] vs 1.13 years [95% CI, 1.01-1.28]; P < .01). Overall, in the year following their diagnosis, NHAA patients were observably less likely to receive treatments than NHW patients (HR, 0.84; 95% CI, 0.77-0.93).

Within the subgroup of treated patients, NHW patients demonstrated longer median survival than NHAA patients (P < .01); however, among the patients who did not receive treatment in the first year, the authors did not observe any significant differences in survival outcomes).

“The gap may be related to the affordability of costly medications for MM treatment, such as lenalidomide,” Rong Wang, lead investigator, and colleagues write. “Moreover, the financial burden would increase over time given that the average net price of one lenalidomide pill increased from $215 in 2005 to $719 in 2019,23 and the estimated median annual out-of-pocket cost of lenalidomide alone for patients with [Medicare] Part D coverage increased by $2923 from $11,538 in 201626 to $14,461 in 2019.”

The authors concluded that the claim-based nature of their study and how this element made it difficult to analyze the factors contributing to delayed treatment initiation. For this reason, they advocate for continued investigations into the treatment barriers affecting patients with MM.

Reference

Wang R, Neparidze N, Ma X, Colditz GA, Chang S, Wang S. Racial differences in treatment and survival among older patients with multiple myeloma. Cancer Med. 2024 Jan 17. doi: 10.1002/cam4.6915