Dr Matous on Factors Influencing Treatment Selection and Sequencing in Multiple Myeloma

Jeffrey V. Matous, MD, clinical professor of medicine, University of Colorado Health Sciences Center, member physician, Colorado Blood Cancer Institute, discusses factors to be considered when determining the optimal sequencing of bispecific antibodies in multiple myeloma.

The selection and sequencing of currently available therapies with similar targets in multiple myeloma is dependent on several factors, including the availability of options at a given treatment center as well as patients’ unique circumstances, Matous says. Some academic centers, like the Colorado Blood Cancer Institute, offer a range of therapeutic options, including CAR T-cell therapy, clinical trials, and T cell–redirecting antibodies, he adds. However, community or rural practices may have a more limited array of options, according to Matous. As CAR T-cell therapy may not be feasible to integrate into community practice, bispecific antibodies may become a more promising option for patients in these locations, Matous adds.

Urgency also plays a critical role in treatment decision making. CAR T-cell therapy typically involves a waiting period of 5 weeks from cell collection to treatment. If immediate intervention is necessary for a patient, bispecific antibodies like teclistamab (Tecvayli) could represent a quicker alternative, Matous says.

Proximity to treatment centers is another consideration. Patients who live far away from the center might find weekly or biweekly visits for bispecific antibody treatment burdensome, whereas CAR T-cell therapy is administered through a single administration, Matous explains.

Regarding the sequencing of these drug classes, current data support the use of CAR T-cell therapy as initial treatment followed by bispecific antibodies in the event of disease recurrence. This sequential strategy allows for initial targeted treatment followed by a salvage option against the same or different targets, Matous states.

Ultimately, the choice of therapy is highly individualized and depends on a combination of these factors, ensuring that the selected treatment aligns with the patient’s specific needs, urgency, and circumstances, Matous concludes.