MULTIPLE MYELOMA

Peers & Perspectives in Oncology editorial board member Marc J. Braunstein, MD, PhD, FACP, discussed the significant advancements in multiple myeloma treatment at the 2024 ASH Annual Meeting and Exposition.

The FDA granted orphan drug designation to OPN-6602 for the potential treatment of relapsed/refractory multiple myeloma.

Idecabtagene vicleucel induced high complete response and minimal residual disease negativity rates in multiple myeloma after suboptimal first-line therapy.

Binod Dhakal, MD, MS, discussed the use of bispecific antibodies and chimeric antigen receptor T-cell therapy in relapsed/refractory multiple myeloma treatment.

Ciltacabtagene autoleucel improved minimal residual disease negativity and sustained responses vs standard care in lenalidomide-refractory multiple myeloma.

One concern with bispecific antibody therapies in community settings is managing adverse events, with emerging patterns guiding management strategies.

During a Case-Based Roundtable® event, Muhammad Umair Mushtaq, MD, discussed managing long-term toxicity concerns related to CAR T-cell therapy in multiple myeloma.

The FDA has accepted the resubmitted biologics license application for linvoseltamab to treat relapsed/refractory multiple myeloma in heavily pretreated adults.

Panelists discuss how to optimize maintenance therapy following autologous stem cell transplantation by evaluating factors such as duration, drug selection, and risk-adapted approaches to maximize long-term outcomes in multiple myeloma patients.

Panelists discuss how the paradigm in transplant-eligible newly diagnosed multiple myeloma (NDMM) has shifted to considering which patients should not receive quadruplet CD38-containing regimens rather than who should, given the compelling efficacy data supporting this approach.

The panelist discusses how for managing patients with R/R multiple myeloma, community clinicians should focus on personalized treatment approaches, incorporating novel therapies such as CAR T-cell therapy while carefully monitoring for and managing toxicities through established protocols. Key considerations include implementing systematic toxicity management strategies, maintaining long-term patient monitoring, and staying informed about emerging therapeutic options. The field is evolving with promising novel agents and combination approaches being investigated, particularly for patients who progress after initial treatments.

Ashraf Z. Badros, MB, ChB, discusses the next steps following the phase 3 AURIGA trial of daratumumab and lenalidomide vs lenalidomide maintenance in patients with newly diagnosed multiple myeloma.

Panelists discuss how the PERSEUS trial demonstrated superior progression-free survival with daratumumab-VRd compared to VRd alone in patients with transplant-eligible newly diagnosed multiple myeloma (NDMM), potentially establishing a new standard of care in this setting.

Panelists discuss how to navigate and choose among multiple guideline-recommended induction regimens for patients with transplant-eligible newly diagnosed multiple myeloma (NDMM) by considering factors such as efficacy data, toxicity profiles, and individual patient characteristics.

The panelist discusses how real-world evidence for CAR T in relapsed/refractory multiple myeloma shows promising efficacy but with some differences from clinical trials. Ide-cel demonstrates effectiveness in patients with prior BCMA exposure, though responses may be impacted. Compared with standard of care (SOC), both ide-cel and cilta-cel show superior outcomes in terms of response rates and progression-free survival, though long-term data are still emerging in real-world settings.

The panelist discusses how the KarMMa-3 trial data demonstrated the superior efficacy of ide-cel vs standard regimens in triple-class exposed R/R MM, with a median progression-free survival of 13.3 vs 4.4 months and an overall response rate of 71% vs 42%. The favorable safety profile and significant survival benefit support ide-cel as a preferred option for third-line and greater treatment, particularly in patients with good performance status who can tolerate bridging therapy.

Panelists discuss how to optimize treatment selection and sequencing for a 65-year-old patient with standard-risk, transplant-eligible newly diagnosed multiple myeloma (NDMM) through assessment of disease characteristics, patient factors, and available therapeutic options.

Panelists discuss how the IMROZ trial demonstrated improved outcomes with quadruplet therapy combining daratumumab, lenalidomide, melphalan, and prednisone in patients with transplant-ineligible newly diagnosed multiple myeloma (NDMM), highlighting its potential as a new treatment standard.

Ashraf Z. Badros, MB, ChB, discusses the results of the phase 3 AURIGA trial which evaluated daratumumab and lenalidomide vs lenalidomide maintenance in patients with newly diagnosed multiple myeloma.

Ashraf Z. Badros, MB, ChB, discusses the background, methods, and design of the phase 3 AURIGA trial.

The panelist discusses how the treatment landscape for early-stage relapsed/refractory multiple myeloma (R/R MM) has evolved significantly with CAR T-cell therapies (idecabtagene vicleucel, ciltacabtagene autoleucel [ide-cel, cilta-cel]) and novel drug combinations. Treatment selection now considers prior therapies, patient characteristics, and response duration. For third-line chimeric antigen receptor (CAR) T after no prior CAR T use, cilta-cel shows favorable efficacy data with deeper, more durable responses than ide-cel, though both are viable options.

The panelist discusses how the patient had triplet therapy 6 years ago, which was the standard for myeloma treatment at the time. Since then, the patient has had a biochemical relapse, renal insufficiency, and moderate anemia, so he needs therapy but not immediate therapy.

Panelists discuss how the CEPHEUS trial demonstrates the comparative efficacy and safety of subcutaneous daratumumab combined with VRd vs VRd alone in patients with transplant-ineligible or transplant-deferred newly diagnosed multiple myeloma, highlighting key outcomes and clinical implications.

Bispecific antibody therapy is transforming cancer treatment, especially in multiple myeloma, with ongoing studies exploring early-line and maintenance use.

During a Case-Based Roundtable® event, Rahul Banerjee, MD, discussed approaches to dosing and tolerability when using talquetamab in patients with relapsed/refractory multiple myeloma.

The phase 3 IRAKLIA trial of subcutaneous isatuximab met its co-primary end points in multiple myeloma.

Panelists discuss how guideline-recommended treatment regimens for patients with transplant-ineligible or transplant-deferred newly diagnosed multiple myeloma should be evaluated and selected based on patient characteristics, efficacy data, and safety profiles to achieve optimal outcomes.

Panelists discuss how intravenous immunoglobulin (IVIG) therapy may reduce infection risk in patients with multiple myeloma who are receiving teclistamab treatment.

Panelists discuss how minimal residual disease assessment demonstrates superior depth of response with ciltacabtagene autoleucel compared with standard of care in patients who have lenalidomide-refractory multiple myeloma and received 1 to 3 prior therapies.

Panelists discuss how adding a fourth drug (daratumumab) to standard triplet induction therapy may improve outcomes for patients with newly diagnosed, transplant-eligible multiple myeloma.