COMy 2023 | The growing importance of CELMoDs in the treatment of R/R multiple myeloma

At this morning’s session we were discussing the management of frailer patients with relapsed/refractory disease or patients who live in community settings and really need oral therapies as opposed to complicated or more sophisticated access to tertiary centers for inpatient stays and so on. And so therefore CELMoDs is such an interesting and exciting new area. These are all oral of course, iberdomide, which is the first in the group to have been studied in the relapsed/refractory setting, is now moving upfront. The more powerful relapsed/refractory drug of choice we hope will turn out to be mezigdomide. This is particularly powerful in relapsed/refractory disease. We’ve established a one milligram three weeks on, one week off schedule for when we’re just using mezigdomide with dexamethasone. When we combine it with other key drugs such as bortezomib or carfilzomib or for that matter antibody therapy, you can afford to dose it at a lower level and see tremendous activity. But what we showed above all with the mezigdomide-dex, just two drugs, mezigdomide with low dose dexamethasone, we showed that in triple-class refractory patients and in BCMA exposed patients and those patients with extramedullary disease, we showed impressive activity specifically for the group. Overall it was around a 41% response rate even though they were also heavily pretreated. But if we looked at the BCMA exposed patients which included antibody-drug conjugate exposure, bispecifics and CAR-T, we were able to show in that group of exquisitely vulnerable patients a response rate in excess of 50%, which is very exciting. For patients with extramedullary disease, recognize that’s a particularly challenging group of patients to treat, we saw a response rate of over 30%. So again, this was really exciting because it suggests to us we’ve got an all oral approach with a manageable safety profile and that could be very promising in this setting.