The Impact of Evolving Treatment Options in Multiple Myeloma, Part 10

Bruce A. Feinberg, DO: Joe, in the closing minute you had one other thing you wanted to bring up before Tom spoke?

Joseph Mikhael, MD: I was just saying when we think of the future of multiple myeloma, we have talked about many of these immune agents that are being developed and there are so many of them, including CAR T [chimeric antigen receptor T-cell therapy]. There’s even this concept of AlloCAR T [allogeneic chimeric antigen receptor T-cell therapy] where we may be able to avoid the challenge of collecting the patient’s own T cells and taking 4 weeks to manufacture them and give them back. We may be able to actually exogenously give someone T cells, but let’s not forget we are still doing research in multiple other realms, in which one towards the top of list would be the new class of CELMoDs [Cereblon E3 ligase modulator] that are really cell modulators that are quite similar to the current immunomodulatory drugs that we are using. We could even argue they are part of the same class, so iberdomide is the first in this class. This is a very conveniently delivered oral drug, very similar to what we are using now with lenalidomide [Revlimid] and pomalidomide [Pomalyst] that may likely be available to us in the near future. It’s cutting its teeth on pomalidomide resistance, so even though we are blessed to have 2 different immunomodulatory drugs eventually the disease becomes resistant to both of them and so having another drug that is oral with some toxicity of course, but minimal toxicity may be a valuable addition to our armament before long.

Bruce A. Feinberg, DO: RVd [lenalidomide, bortezomib (Velcade), and dexamethasone] has had a near 2 decade run. If we do this again in 3 years, is it still the foundational treatment? We’ll go down the horn. Joe, will it still be the foundational treatment?

Joseph Mikhael, MD: I think here in the United States there are going to be some changes to that. I do think with time we are going to try and use a proteasome inhibitor that may be less neuropathy invoking but at the same time it’s still tried and true. I think the issue is not so much going to be changing RVd as much as adding a quadruplet to it, adding daratumumab [Darzalex] or isatuximab [Sarclisa] to it.

Ryan Haumschild, PharmD, MS, MBA: I think that there are going to be newer things introduced in the frontline setting. I am really excited about that. I think in the future, 3 years may be pushing it but there are so many changes here recently especially things that we’re studying. I would really love to see somebody challenge that, and reduce some of the toxicities and side effects there and actually improve some of the complete responses that we are going for. I am really excited about what the future holds, and I feel like a lot of these therapies that we are introducing in later lines of therapy and we’ll continue to see them move up across the treatment landscape.

Bruce A. Feinberg, DO: And Tom, last word.

Thomas Ollis, MS, RPh: I agree with Ryan and Joe. I think it’s exciting. I do see us going from maybe all IV [intravenous] therapy to maybe some more oral therapies. To even start with possibly an oral therapy, maybe not in 3 years, maybe a little longer. But I think we have every reason to be optimistic.

Bruce A. Feinberg, DO: Guys fabulous. I loved it. Great content. Lots and lots for the audience to digest. We need to have a manual to go along with this, so we have something in writing. I feel like I needed closed captions. I am going to thank you all for this rich and informative discussion. I want to thank all of you who are watching and being our viewing audience. We hope you enjoyed this AJMC® webcast and we hope you found it to be useful and informative and join us for the next one. I am Dr. Bruce Feinberg. See you all.

Joseph Mikhael, MD: Thank you.

Thomas Ollis, MS, RPh: Thank you.

Ryan Haumschild, PharmD, MS, MBA: Thanks.

Transcript Edited for Clarity