Myeloma Now: Insights and Innovations

In this comprehensive expert update with Doria Hansen, MD of Moffitt Cancer Center, on the evolving treatment landscape for multiple myeloma, the focus turns to innovations in T-cell–based therapies and the implications of recent clinical trial data. The discussion covers current FDA-approved CAR T-cell therapies like ide-cel and cilta-cel, and their move into earlier lines of therapy, supported by promising 5-year follow-up data from the CARTITUDE-1 trial. Investigational CAR T products such as anito-captagene autoleucel (anito-cel), and arlocaptigene autoleucel (arlo-cel), are also discussed, including their efficacy, safety, and novel targets.

Dual-targeted CAR T-cell therapies (e.g., BCMA and GPRC5D) and trispecific antibodies are highlighted as areas of innovation, with clinical studies demonstrating response rates approaching 100%. The emergence of fast-CAR technology is noted for its potential to reduce manufacturing time and streamline access.

Minimal residual disease (MRD) negativity is emphasized as a predictive marker of durable response, with recent ODAC data and studies supporting its use in therapeutic decision-making.

Sequencing strategies for BCMA-targeted therapies are discussed, particularly in patients with prior exposure. New guidance from the International Myeloma Working Group suggests a preference for BCMA CAR T-cell therapy over BCMA bispecifics, when feasible.

Dr. Hansen also addresses future considerations in therapy design, including understanding mechanisms of relapse, mitigating neurologic and off-target toxicities, and enhancing predictive modeling and manufacturing reliability.

She concludes the interview with a look at cevostamab, a bispecific antibody targeting FcRH5, which has shown promise in patients previously treated with BCMA therapies, offering new hope and avenues for clinical intervention.