IMS 2023 | Perspectives of physicians regarding MRD assessments to guide decision-making in myeloma

Half of the abstracts here [at IMS2023] are about MRD. In the academic community, we love talking about MRD, looking at trials that use MRD, talking about what exponents to use to define MRD. Dr Derman from the University of Chicago did a very elegant survey of physicians, primarily academic, about two years ago, that showed that about 60% of physicians, again primarily academic, were using MRD or at least checking for MRD in their patients. About one-third of them were using it to guide their decision-making. We were interested in saying, well let’s do that survey again, but with a different cohort, this time primarily community based. The big difference between that one and this one is that now we’re looking at physicians who have self-reported that they are mainly in their community.

The biggest thing that we found, the thing that surprised me, was that we had around 70 physicians who responded, 70% of them community based, who reported checking MRD on average in about 40-50% of their patients, which is much higher than I would expect, because technically MRD is not in our standard of care anywhere. It’s used in a lot of trials, we talk about MRD as a prognostic endpoint, but in terms of using it for the patient sitting in front of you, I only do it after careful decision making and talking with the patient about the data. Here, 40% of community doctors who treat every kind of cancer, they know what MRD is, they’re checking it in their patients and about a third of physicians who said that they check MRD, use it to guide treatment decisions, for example to deescalate therapies. There are other take aways from that – we found that these community-based physicians, primarily in the U.S., are also using peripheral blood mass spectrometry commonly. We found that gene expression profiling is probably less used, 5-10% of them use it routinely in their patients. So, there’s a lot that’s evolving. It’s funny that if you could look at comparing GEP to MRD, MRD has come into the limelight much more recently but is now being used much more commonly. The main take away for me is that as we, from the academic side, can come to meetings like this and keep talking about MRD, people are listening and our colleagues in the community are using it, and I think it’s important to recognize that.