Impact of the affordability of novel agents in patients with multiple myeloma: Real‐world data of current clinical practice in Mexico

• Published in: Cancer Vol. 124; no. 9; pp. 1946 - 1953
• Main Authors: Tarín‐Arzaga, Luz, Arredondo‐Campos, Daniela, Martínez‐Pacheco, Victor, Martínez‐González, Odra, Ramírez‐López, Alba, Gómez‐De León, Andrés, Gutiérrez‐Aguirre, Cesar Homero, Cantú‐Rodríguez, Olga, Jaime‐Pérez, José Carlos, Gómez‐Almaguer, David
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.05.2018
• Subjects: Autografts; Bortezomib; Cancer; Confidence intervals; Income; middle income; Multiple myeloma; novel agents; Oncology; outcome; Patients; Public health; Stem cell transplantation; Stem cells; Survival; Thalidomide; Transplantation; Mexico; multiple myeloma; novel agents; outcome; middle income; transplantation
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.31305

BACKGROUND The treatment of multiple myeloma (MM) has become costly and difficult to access for patients living in low‐income to middle‐income countries. METHODS The current retrospective study included 148 patients in Mexico with newly diagnosed MM, and was performed to compare the outcomes of patients with and without access to novel agents. The records of 77 patients admitted to a public hospital (PubC) and 71 patients cared for within private health systems (PrivC) from November 2007 to July 2016 were reviewed. RESULTS Compared with those treated in PrivC, patients receiving care at PubC were more likely to be diagnosed with advanced disease. A thalidomide‐based regimen was the most common induction treatment used at PubC, whereas a bortezomib‐based regimen was used most often in PrivC. The median follow‐up was 41 months. Patients in PrivC demonstrated better response rates and survival; 65% of patients treated in PrivC versus 41% treated at PubC achieved a very good partial response or better (P = .005). The median progression‐free survival and median overall survival were 23 months and 51 months, respectively, for patients treated at PubC and 41 months and 79 months, respectively, for those treated in PrivC (P<.001). More patients underwent autologous stem cell transplantation in PrivC. When adjustments were made for covariates, patients treated at PubC experienced a higher risk of death compared with patients receiving care in PrivC (hazard ratio, 2.0; 95% confidence interval, 1.0‐4.3 [P = .04]). CONCLUSIONS Stage at diagnosis, induction regimen, and autologous stem cell transplantation were found to be contributors to survival disparities between patients with MM treated at PubC compared with PrivC in Mexico. These findings underscore the need to improve access to novel agents and stem cell transplantation in public health systems. Cancer 2018;124:1946‐53. © 2018 American Cancer Society. Patients with newly diagnosed multiple myeloma who receive care within a private health system appear to have higher response rates and better survival compared with those who receive treatment at a public health care institution and have no access to novel agents and stem cell transplantation. A lack of health insurance coverage in a middle‐income country is a critical barrier to receiving newer generation multiple myeloma drugs and related medical care that impacts prognosis.