WHAT IS

What is MM?

A recurring, multi-stage cancer with a long, demanding treatment journey

ELUSIVE & DIFFICULT-TO-DIAGNOSE. MM (Multiple Myeloma) is a slowly escalating hematological cancer primarily occurring in the bone marrow. It chiefly affects older adults, more commonly men, with a mean age of diagnosis of 69 years.

MM is notoriously difficult to detect. Many can have it for months or years before diagnosis, without even knowing they are sick. In fact, only 5% are diagnosed in the early stages (giving them a 71% 5-year survival rate), with the vast majority receiving a later-stage diagnosis and a 50% 5-year survival rate with chemotherapy. First-line chemotherapies are effective, but can cause severe, challenging side effects that can be more disabling than the disease symptoms for some patients, making it difficult for them to adhere to their treatment regimes.

PREVALENCE

  • 140,000 (approx.) people in the US currently have MM (1)NIH, SEER, Multiple Myeloma
  • 25,000 (approx.) new cases occur annually in the US (roughly 7.5 per 100,000)
  • 30,000 (approx.) new cases occur annually in France, Germany, Italy, Spain and UK (2)Datamonitor Healthcare, MM Epidemiology 2018
  • 81,050 is the number of new cases forecast to occur in the US, Japan, France, Germany Spain, Italy and the UK by 2037, an increase of 39.3% (3)Global Data Multiple Myeloma Forecasts, 2019

DYNAMIC TREATMENT LANDSCAPE. MM follows a relapsing pattern, where patients go through several lines of treatment – with periods of remission followed by relapses as the cancer cells become resistant to the treatment. Because of this, newly approved drugs for MM appear relatively regularly. Survival rates have been extended in recent years, through new treatments and existing ones – including the ImiD’ class of immunomodulatory drugs, with its core first-line chemotherapy Lenalidomide (commercial name Revlimid).

LENALIDOMIDE: CORE CHEMOTHERAPY
WITH POOR COMPLIANCE.

Lenalidomide is an oral thalidomide analog with multiple effects on tumor cells and the tumor microenvironment. Patients take Lenalidomide daily as an oral tablet (25mg) for 21 days continuously in a 28-day cycle. Whilst Lenalidomide is undoubtedly effective (4)Multiple Myeloma Research Foundation (Revlimid clinical studies have shown improved survival in patients with newly diagnosed/untreated MM and in patients following stem cell transplants) side effects can be severe – and for some more disruptive and uncomfortable than their MM symptoms.

Diarrhea, fatigue and nausea are commonly reported, but more severe side effects can include Deep Vein Thrombosis (10% of MM patients who take Lenalidomide immediately after diagnosis) and pulmonary embolism (4% of MM patients taking Lenalidomide after other MM treatments that were not effective) (5)Medical News Today Long-term use can also lead to higher risk of new and / or secondary malignancies (6)Revlimid – https://www.revlimid.com/serious-side-effects.

(1) NIH, SEER, Multiple Myeloma
(2) Datamonitor Healthcare, MM Epidemiology 2018
(3) Global Data Multiple Myeloma Forecasts, 2019
(4) Multiple Myeloma Research Foundation
(5) Medical News Today
(6) Revlimid – https://www.revlimid.com/serious-side-effects

Patient Case

PATIENT CASE

Meet Ian

I took 25mg orally of Lenalidomide daily, plus 40mg of dexamethasone weekly to help with the nausea. I had diarrhoea and fatigue but was told that was fairly common. In the second week I started getting fevers out of the blue. 38 or higher, which knocked me sideways. Some people taking Lenalidomide can get neutropenia they told me, a low white blood cell count. That can then lead to febrile neutropenia – which is what the sweating and fevers were.
The hardest thing for me was that I was diagnosed one month after my first granddaughter was born. They live locally, and I’d really been looking forward to helping out. I knew I’d never have that time again, so I was often tempted to stop the meds just to be able to escape the side effects and be with her more. Even holding her was a struggle sometimes. But, I’m still here – and still enjoying seeing her, so I’m glad I kept going.

DIAGNOSIS: Ian, a busy Supply Chain Manager, was diagnosed with MM at 61, a month after the birth of his first granddaughter.

PROGNOSIS: Ian received a survival prognosis of 4-5 years that could be extended – if treatment started immediately. 45% of MM patients begin taking Lenalidomide immediately after diagnosis.

IMPACT: Ian took Lenalidomide as an oral treatment in combination with the steroid dexamethasone: 25 mg of Lenalidomide every day at the same time, on days 1–21 of a 28-day cycle. 40 mg of dexamethasone on days 1, 8, 15 and 22 of the cycle. For Ian the side effects were disruptive. They included diarrhoea and fatigue – and recurrent fevers, as a result of neutropenia, which was caused not by the MM but the therapy.

CONTROLLED RELEASE

Controlled release, increased compliance

Patient Case

NEX-20 would replace daily doses of lenalidomide throughout 21 days – with a single monthly injection administered in-clinic

OVER ONE THIRD OF MM PATIENTS HAVE POOR COMPLIANCE: A recent study of 793 patients showed that 38%, over a third, were considered to have poor adherence to lenalidomide, using the medication possession ratio as a surrogate for adherence. (1)Clin Lymphoma Myeloma Leuk. 2020;20(2):98-104

Over one third of older adults with newly diagnosed MM are considered to have poor adherence to lenalidomide. This highlights the need to further understand factors and devise strategies to support adherence in this patient cohort.
Clinical Lymphoma Myeloma and Leukemia

CONTROLLED RELEASE, INCREASED COMPLIANCE: Today’s oral administration makes it relatively easy for patients struggling with side effects to simply stop taking their required medication. Lenalidomide administered once a month, in-clinic, by syringe, could significantly improve compliance and adherence.

This makes co-payments for patients cheaper, and gives healthcare providers in the US the added incentive that on-site injections result in continuous reimbursement compared to prescribed tablets
US Key Opinion Leader, Texas

(1) Clin Lymphoma Myeloma Leuk. 2020;20(2):98-104