title: Systematic Literature Review and Network Meta-Analysis of Treatment Outcomes in Relapsed and/or Refractory Multiple Myeloma.
abstract: Purpose Since 2000, many new treatment options have become available for relapsed and/or refractory multiple myeloma (R/R MM) after a long period in which dexamethasone and melphalan had been the standard treatment. Direct comparisons of these novel treatments, however, are lacking. This makes it extremely difficult to evaluate the relative added value of each new treatment. Our aim was to synthesize all efficacy evidence, enabling a comparison of all current treatments for R/R MM. Methods We performed a systematic literature review to identify all publicly available phase III randomized controlled trial evidence. We searched Embase, MEDLINE, MEDLINE In-Process, Cochrane Central Register of Controlled Clinical Trials, and the Web site www.ClinicalTrials.gov . In addition, two trials presented at two international hematology congresses (ie, ASCO 2016 and European Hematology Association 2016) were added to include the most recent evidence. In total, 17 randomized controlled trials were identified, including 18 treatment options. The evidence was synthesized using a conventional network meta-analysis. To include all treatments within one network, two treatment options were combined: (1) bortezomib monotherapy and bortezomib plus dexamethasone, and (2) thalidomide monotherapy and thalidomide plus dexamethasone. Results The combination of daratumumab, lenalidomide, and dexamethasone was identified as the best treatment. It was most favorable in terms of (1) hazard ratio for progression-free survival (0.13; 95% credible interval, 0.09 to 0.19), and (2) probability of being best (99% of the simulations). This treatment combination reduced the risk of progression or death by 87% versus dexamethasone, 81% versus bortezomib plus dexamethasone, and 63% versus lenalidomide plus dexamethasone. Conclusion Our network meta-analysis provides a complete overview of the relative efficacy of all available treatments for R/R MM. Until additional data from randomized studies are available, on the basis of this analysis, the combination of daratumumab, lenalidomide, and dexamethasone seems to be the best treatment option.
authors.affiliation: Chrissy H.Y. van Beurden-Tan and Pieter Sonneveld, Erasmus MC Cancer Institute; Margreet G. Franken, Hedwig M. Blommestein, and Carin A. Uyl-de Groot, Erasmus University Rotterdam, Rotterdam; and Hedwig M. Blommestein and Carin A. Uyl-de Groot, Comprehensive Cancer Organisation, Utrecht, the Netherlands.
authors.forename: Chrissy H Y
authors.initials: CHY
authors.lastname: van Beurden-Tan
authors.affiliation: Chrissy H.Y. van Beurden-Tan and Pieter Sonneveld, Erasmus MC Cancer Institute; Margreet G. Franken, Hedwig M. Blommestein, and Carin A. Uyl-de Groot, Erasmus University Rotterdam, Rotterdam; and Hedwig M. Blommestein and Carin A. Uyl-de Groot, Comprehensive Cancer Organisation, Utrecht, the Netherlands.
authors.forename: Margreet G
authors.initials: MG
authors.lastname: Franken
authors.affiliation: Chrissy H.Y. van Beurden-Tan and Pieter Sonneveld, Erasmus MC Cancer Institute; Margreet G. Franken, Hedwig M. Blommestein, and Carin A. Uyl-de Groot, Erasmus University Rotterdam, Rotterdam; and Hedwig M. Blommestein and Carin A. Uyl-de Groot, Comprehensive Cancer Organisation, Utrecht, the Netherlands.
authors.forename: Hedwig M
authors.initials: HM
authors.lastname: Blommestein
authors.affiliation: Chrissy H.Y. van Beurden-Tan and Pieter Sonneveld, Erasmus MC Cancer Institute; Margreet G. Franken, Hedwig M. Blommestein, and Carin A. Uyl-de Groot, Erasmus University Rotterdam, Rotterdam; and Hedwig M. Blommestein and Carin A. Uyl-de Groot, Comprehensive Cancer Organisation, Utrecht, the Netherlands.
authors.forename: Carin A
authors.initials: CA
authors.lastname: Uyl-de Groot
authors.affiliation: Chrissy H.Y. van Beurden-Tan and Pieter Sonneveld, Erasmus MC Cancer Institute; Margreet G. Franken, Hedwig M. Blommestein, and Carin A. Uyl-de Groot, Erasmus University Rotterdam, Rotterdam; and Hedwig M. Blommestein and Carin A. Uyl-de Groot, Comprehensive Cancer Organisation, Utrecht, the Netherlands.
authors.forename: Pieter
authors.initials: P
authors.lastname: Sonneveld
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000069286:Bortezomib / Q000008:administration & dosage / Q000627:therapeutic use*; D017326:Clinical Trials, Phase III as Topic; D003907:Dexamethasone / Q000008:administration & dosage; D006801:Humans; D009101:Multiple Myeloma / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D013792:Thalidomide / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D020533:Angiogenesis Inhibitors; D000970:Antineoplastic Agents; D013792:Thalidomide; D000069286:Bortezomib; D003907:Dexamethasone