The survival rate of patients with multiple myeloma increased following new drug development. However, concerns have been raised that South Korea's survival rate is still far from that of advanced countries.

Expert opinions indicate that the Korean medical treatment field changes with new drug approvals and reimbursement listings, yet patient access remains restricted.

During the conference commenced by Janssen on October 28th, Dr. Chang Ki Min, a Professor of Hematology at Seoul St. Mary's Hospital, emphasized the need for early treatments customized to the nature of multiple myeloma.

According to the Health Insurance Review and Assessment Service (HIRA), the number of Korean patients with multiple myeloma is on the rise due to the aging population. Multiple myeloma patients were 7,063 in 2017, and the number increased to 11,219 patients in 2023.

"The average multiple myeloma onset is 60 years or higher. As the aging population continues to increase, the number of multiple myeloma patients will likely increase as well," Dr. Min explained.

The problem is that remission of multiple myeloma is difficult to achieve. Despite undergoing treatments, patients are likely to experience relapse. Therefore, treatment focuses on selecting effective treatments in each stage and extending the progression-free survival period.

Typically, treatment duration shortens as the number of treatments increases. For example, 95% of patients undergoing first-line treatment relapse, 15% of patients undergoing fourth-line treatment relapse, and the percentage drops to 1% by the time patients receive fifth-line treatment.

"When multiple myelomas relapse after several years following treatment at an early stage, the disease becomes chronic. It is important to undergo effective treatment at early stage so that the disease does not advance to secondary, tertiary, etc," said Dr. Min.

As new drugs are being developed for treating multiple myeloma, a variety of treatment options are available.

Originally starting from simple chemotherapy, the treatment evolved to combination therapies, including proteasome inhibitors, immune modulators, and high-dosage steroids. Recently, new treatments, such as anti-CD38 monoclonal antibodies and BCMA-targeted immune therapy, became available.

In South Korea, new treatment options are emerging as new drugs for treating multiple myeloma receive the Ministry of Food and Drug Safety (MFDS) approvals: elranatamab in May and Talvey in June.

However, the limitation to utilizing such treatments is that the National Health Insurance reimbursement is limited.

A 'DVTd combination therapy (Darzalex+bortezomib+thalidomide+dexamethasone),' containing Darzalex (daratumumab), recently received an appropriateness decision from the Drug Reimbursement Evaluation Committee (DREC) for expanding reimbursement as the first-line treatment of multiple myeloma. However, analysis suggests that the medical field still needs overall improvement.

"Within the limited government fund, many pharmaceuticals are covered by reimbursement. Yet, there still needs improvement based on the global standard," Dr. Min said. "Despite having good treatment options, including existing medications and new drugs, patient access is limited. Thus, it requires improvement."

The survival rate of Korean patients with multiple myeloma is 51%, showing a 10% difference compared to that of advanced countries, 61% in the United States and 62% in Germany.

Consequently, the Korean medical field is changing due to new drug approvals and reimbursement listings. Various approaches may be needed to improve treatment outcomes, such as considering treating the disease at an early stage and optimizing the order of treatments.

Dr. Min has suggested an improvement plan as ▲Early use of the monoclonal antibody combination therapy ▲Triple combination drug that can be used in patients who are non-responsive to Lenalidomide ▲A new class treatment for patients relapse or refractory to over third-line therapies.

It suggests that administering a new drug that would significantly improve the survival rate at an early stage could achieve both the treatment effects and the National Health Insurance finance.

"We understand the problem of limited National Health Insurance finance, but we expect that early administration of an effective treatment method would reduce relapse rate and increase the survival rate, thereby potentially reducing the treatment cost," Dr. Min said. "Most patients currently undergo 6th and 7th treatments. Using effective treatments at an early stage will, in turn, be effective for the National Health Insurance."

Lastly, Dr. Min added, "It would be difficult for patients to fully experience the treatment effects when effective medications are used in patients with poor conditions after the 3rd and 4th treatments. By administering treatments early, we expect to see the global standard therapy results."