Future of Myeloma Treatment ‘Quite Exciting’ With New Immunotherapies

EP: 1.SWOG S0777 Trial Proves VRd To Be Viable Option for Untreated Myeloma That Is Unintended for ASCT

EP: 2.Expert Offers Considerations For Frontline Combination Therapies in Multiple Myeloma

EP: 3.Ongoing Trials May Pave Way To Bring Later-Line Therapies Upfront in Newly Diagnosed Multiple Myeloma

EP: 4.MAIA trial Supports Use of D-Rd in Transplant-Ineligible Patients With Myeloma

EP: 5.GRIFFIN Trial Supports Use of Dara-VRd in Transplant-Eligble Patients With Myeloma

EP: 6.Ongoing Trials Aim to Determine Best Regimen for Transplant-Ineligible Patients With Myeloma

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EP: 7.Future of Myeloma Treatment ‘Quite Exciting’ With New Immunotherapies

EP: 8.Recap: Alabama and Washington Universities Face-Off on Multiple Myeloma at ASH

As part of CancerNetwork’s Face-Off video series, Luciano J. Costa, MD, PhD, professor of medicine - hematology and oncology, Department of Medicine, University of Alabama at Birmingham, discussed the future treatments being evaluated for the treatment of multiple myeloma.

Costa: There are a lot of things that we're watching with great anticipation in the newly diagnosed myeloma scenario. One of them is the idea of response-adaptive therapy. Up to now, we learn that a therapy is better or not by comparing its performance in a population of patients with myeloma. And those therapies are usually given for a certain plane or into progression or intolerance, but has been very little in the way of adapting response; definitely therapy to the depth of response. And that is definitely a need because myeloma being such a heterogeneous disease, there are patients who are probably being undertreated, particularly patients with high-risk disease, despite receiving even quadruple therapy, transplant, but they're also likely to have patience for being overtreated.

So I think in the near future, we'll be asking questions, not to the whole universe of myeloma patients but to a subset defined by the depth of their response. And perhaps, the greatest example that is well underway, is the French study group [NCT03652064], where the patients receive a longer duration of quadruplet therapy, and then they are randomized for specific questions based on the achievement of [minimal residual disease (MRD)] negativity, essentially asking a de-escalation of therapy question on patients with MRD negative and escalation of therapy question on patients who are MRD positive.

The other element that I think I myself and I'm sure my colleagues are watching with great excitement is that we're seeing revolutionary innovations in the management of patients with multiple relapses, patients with triple-class-refractory myeloma, in the field of immunotherapy, particularly CAR T-cell therapy and bi-specific therapy. And it's very tempting to see how those therapies will perform in earlier lines of therapy. So there are a number of studies underway and are being planned that will deploy bi-specific T-cell engagers and CAR T-cell [therapy] in earlier lines of therapy, which I hope will increase the proportion of patients who have deep, durable responses, I think will likely increase the fraction of patients who are actually cured from myeloma. And then, just as important, provide a path to some patients to be able to be myeloma free and free of going therapy, free of maintenance therapy. So I think the future is quite exciting to this field.

Transcription edited for clarity.