INSIGHT-MM: Impact of PI choice plus Rd on real-world outcomes in RRMM

Results from the real-world observational INSIGHT-MM study (NCT02761187), evaluating outcomes across three different proteasome inhibitors (PIs), plus lenalidomide + dexamethasone (Rd), in patients with relapsed/refractory multiple myeloma (RRMM), were recently published in the European Journal of Haematology by Puig et al. Data from 348 patients were included and evaluated based on the PI-Rd regimen initiated (ixazomib + Rd [IRd], carfilzomib + Rd [KRd], and bortezomib + Rd [VRd]). Endpoints included real-world progression-free survival (rwPFS), best response to therapy, and safety.

Key data: Overall, 356 lines of therapy (IRd, n = 181; KRd, n = 96; VRd, n = 79) were included. After a median follow-up of 17.5 months in the IRd cohort, and 18.4 months in the KRd and VRd cohorts, median rwPFS for the IRd, KRd, and VRd cohorts was 14.5, 13.2, and 9.1 months, respectively. Overall response rates (ORRs) were 60.8% for IRd, 72.2% for KRd, and 58.1% for VRd, with complete response (CR) or better observed in 10.5%, 34.7%, and 11.3% of patients in the IRd, KRd, and VRd cohorts, respectively. The rates of adverse events (AEs) per person-year were similar across treatment groups at 0.46 (95% confidence interval [CI], 0.37–0.57), 0.55 (95% CI, 0.40–0.74), and 0.41 (95% CI, 0.25–0.62) in the IRd, KRd, and VRd cohorts, respectively. 

Key learning: IRd, KRd, and VRd demonstrated comparable real-world efficacy and safety profiles in RRMM, supporting individualized selection of PI-based regimens based on patient-specific factors.