Dr Battiwalla on Addressing Unmet Needs in Multiple Myeloma

Minoo Battiwalla, MD, director, Blood Cancer Outcomes Research, Sarah Cannon Research Institute, discusses remaining unmet needs for patients with multiple myeloma and potential strategies being explored to address these needs.

Myeloma remains a challenging disease with severe manifestations, Battiwalla begins. Although significant progress has been made in the management of standard-risk disease, addressing the needs of high-risk patients remains a critical challenge, he says. In the transplant-eligible population, the use of quadruplet therapy has been effective at mitigating the impact of single cytogenetic high-risk abnormalities on patient outcomes, Battiwalla states. However, the efficacy of this approach for patients with double cytogenetic high-risk abnormalities is still unclear, indicating a need for more effective therapies in this subset of patients, he explains.

For transplant-ineligible patients, the combination of the anti-CD38 monoclonal antibody daratumumab (Darzalex) with lenalidomide (Revlimid) and dexamethasone has proven to be highly effective, Battiwalla continues. Nonetheless, these patients could also benefit from advances made in the transplant-eligible arena, he says. One such advance is the earlier involvement of CAR T-cell therapy, according to Battiwalla. Ciltacabtagene autoleucel (Carvykti; cilta-cel) has demonstrated reduced toxicity when used in the second-line setting compared with its use in the fifth-line setting, making earlier treatment with CAR T-cell therapy a viable option for transplant-ineligible patients, Battiwalla reports. This shift in treatment strategy could potentially improve outcomes for this patient population, he emphasizes.

Another significant unmet need is the incorporation of bispecific antibodies into earlier lines of therapy, Battiwalla says. Bispecific antibodies have shown considerable promise in treating patients with myeloma, but their optimal placement in the treatment paradigm is still being determined, he explains. Finding a home for bispecific antibodies in the earlier-line setting could enhance treatment efficacy and provide new avenues for managing the disease more effectively, Battiwalla emphasizes.

Overall, the focus of research in myeloma must now shift towards developing and integrating more effective therapies for high-risk patients, Battiwalla concludes. This includes optimizing the use of existing therapies, such as quadruplet regimens and CAR T-cell therapy, as well as identifying the best way to incorporate emerging treatments, such as bispecific antibodies.