Oxford Myeloma Workshop 2025 | The uncertainties relating to sequencing in myeloma and optimizing future approaches

Well, I think the sequencing becomes all the more challenging because, of course, we’re using a proteasome inhibitor, an immunomodulator, steroids, and the CD38 antibody first. And should that treatment platform fail a patient, the question then becomes, what do you do? 

So, I think with BCMA-targeted approaches, we now have an obvious, very exciting next step. Then we have beyond BCMA, even newer targets that are equally exciting. So the obvious place is the bispecifics, the CAR-Ts, and to look at these immune therapies. But what I also wanted to explain to everyone today was the excitement around other approaches like antibody drug conjugates, in particular, belantamab mafodotin. The emerging roles of these new very exciting oral agents, the so-called CELMoDs, which include iberdomide, but of course in the relapse setting we have now mezigdomide. And then to speak to other novel small molecules which are very important we think in this setting. 

So sequencing really matters but I think that we’re recognizing that with immune therapies they’re very effective, miraculous in some circumstances, but immune exhaustion and safety are becoming much more important considerations as we better understand how to use the immunotherapy tools we now have and so that’s bringing to the fore how you know going from one immune treatment to another may not be the wiser strategy, that going from one immune platform, bringing in other agents and then moving to an immune therapy later may become very important.

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