ASH 2022 | Treatment options for patients with multiple myeloma who are resistant to daratumumab
Karthik Ramasamy, MBBS, MRCP, FRCPath, PhD, Oxford University Hospitals NHS Foundation Trust, Oxford, UK, comments on the management of patients with relapsed/refractory (R/R) multiple myeloma who become resistant to daratumumab, highlighting the promise of agents targeting BCMA and other novel target antigens in this difficult-to-treat patient population. This interview took place at the 64th ASH Annual Meeting and Exposition congress in New Orleans, LA.
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Transcript (edited for clarity)
Use of daratumumab is now wide and very common, both in the newly diagnosed setting as well as in relapsed setting. In a newly diagnosed setting, using daratumumab is for a limited duration of time and often patients will respond to this treatment, so we don’t see any refractoriness to daratumumab. But when we use daratumumab in the relapsed setting and in the UK, we use it in combination with Velcade and dexamethasone, for first relapse patients, we treat our patients till progression...
Use of daratumumab is now wide and very common, both in the newly diagnosed setting as well as in relapsed setting. In a newly diagnosed setting, using daratumumab is for a limited duration of time and often patients will respond to this treatment, so we don’t see any refractoriness to daratumumab. But when we use daratumumab in the relapsed setting and in the UK, we use it in combination with Velcade and dexamethasone, for first relapse patients, we treat our patients till progression. This would ensure that the patients become CD38-refractory by second relapse. So this is a challenging group of patients for us to manage, if they are refractory to daratumumab and if they were already refractory to lenalidomide, then it becomes difficult to manage these patients.
The only group of treatments that are looking very promising is BCMA-targeted therapy, and belantamab, teclistamab, and BCMA CAR T-cells are all licensed in the setting but they’re not widely available, certainly in Europe as yet. We could consider belantamab-based therapy and there’s a lot of data of belantamab monotherapy in the setting, particularly if patients have had four prior lines of treatment.
Increasingly, we see BCMA bispecific antibodies, of which there are many but teclistamab is the first one that is licensed, will be extremely useful in this setting. The other targets, such as GPRC5D and FCRH5, which are being explored in clinical trials are also extremely exciting for this group of patients, but it defines a group of patients who are very challenging to treat in clinical practice.
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Disclosures
Takeda, Bristol Myers Squibb, Janssen, Amgen, GlaxoSmithKline: Honoraria, Membership on an entity’s Board of Directors or advisory committees, Other: Travel, Research Funding, Speakers Bureau; Sanofi, Adaptive biotech, Oncopeptides: Honoraria, Membership on an entity’s Board of Directors or advisory committees, Speakers Bureau.
