Dr Chari on Current Unmet Needs to Address in Multiple Myeloma Treatment

Ajai Chari, MD, director, Multiple Myeloma Program, professor, clinical medicine, University of California, San Francisco (UCSF), UCSF Helen Diller Family Comprehensive Cancer Center, discusses current unmet needs that remain to be addressed in the treatment of patients with multiple myeloma and highlights what oncologists should know about the current treatment paradigm for this disease.

The current unmet needs in multiple myeloma encompass various patient populations, including elderly patients and those with persistent renal issues, renal failure, frailty, extramedullary disease, plasma cell leukemia, central nervous system relapse, and functional high risk, such as early relapses beyond the expected, Chari begins. These are critical areas requiring focused attention, he adds. Addressing these needs may pose challenges in conducting large, randomized studies, but there's value in incorporating dedicated cohorts within larger phase 3 trials to target these subgroups, such as the frail elderly or patients with renal failure, Chari reports. Although achieving substantial patient sample sizes might be challenging, even smaller cohorts comprising 20 to 30 patients can provide valuable insights into efficacy and safety profiles, facilitating progress in the field, he notes.

Furthermore, in the context of induction therapy, CD38 inhibitors plus lenalidomide (Revlimid) and dexamethasone are commonly considered, with possible inclusion of proteasome inhibitors for transplant-eligible and high-risk elderly patients, he continues. Therefore, adopting triplet or quadruplet regimens for broader patient groups is imperative, Chari says, adding that although transplantation remains a consideration, lenalidomide maintenance therapy with or without additional agents is a recognized treatment approach.

Regarding CAR T-cell therapy, ciltacabtagene autoleucel (cilta-cel; Carvykti) has generated promising results, but concerns persist regarding associated Parkinsonism and cranial neuropathies, he expands. Nonetheless, there's anticipation for the emergence of newer CAR T-cell therapies and bispecific antibodies, with potential combinations offering intriguing prospects, Chari adds. As these therapies advance, there's a growing interest in transitioning them to community settings, according to Chari. Although still in early development stages, it's essential to eventually extend access to these products beyond specialized treatment centers to ensure widespread benefits for patients with myeloma, he concludes.