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IMS 2026 | Treatment sequencing as BCMA-targeted therapies move into earlier lines
Joseph Mikhael, MD, MEd, FRCPC, FACP, Translational Genomics Research Institute (TGen), Phoenix, AZ and International Myeloma Foundation, Studio City, CA, discusses treatment sequencing as BCMA-targeted therapies move into earlier lines of multiple myeloma treatment. He highlights the importance of selecting the most appropriate therapy based on individual patient factors rather than reserving specific modalities, noting that CAR-T therapy, bispecific antibodies and antibody-drug conjugates (ADCs) may remain options across subsequent lines. This interview took place at the 23rd International Myeloma Society (IMS) Annual Meeting in Glasgow, UK.
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Transcript
Ah, the sequencing question. I always say if I’m going to have a meeting tomorrow that I want people to come to, I will call it the optimal sequencing of multiple myeloma and people will come. But I actually am not convinced that there is an optimal sequence because it really depends on patient factors. I really want people to not think about reserving things for later. I think what we do is we give our patient the best opportunity right now to receive the best therapy for them...
Ah, the sequencing question. I always say if I’m going to have a meeting tomorrow that I want people to come to, I will call it the optimal sequencing of multiple myeloma and people will come. But I actually am not convinced that there is an optimal sequence because it really depends on patient factors. I really want people to not think about reserving things for later. I think what we do is we give our patient the best opportunity right now to receive the best therapy for them. Because we’ve learned that when we do that, we get that deep and durable response. It is not going to impair our PFS2, like the later opportunities of treatment for later. And with all of the emerging therapies we have in myeloma, I’m less concerned about, as it were, burning bridges down the line because we know that we are going to have opportunities later. So as BCMA-directed bispecific antibodies come into second-line therapy, we have this choice very often. Do I give a patient a CAR-T cell therapy, a bispecific antibody, or an antibody-drug conjugate, all three of which may target BCMA? And I think the answer is all three of them are valuable. It depends on patient factors, preferences for the patient, comorbidities for the patient, eligibility, that those things can help us choose between them. But I’m not afraid if I choose any one of the three that it’s closing the door to go to the others later. We’ve had patients have CAR-T and then later a bispecific antibody or bispecific antibody and later an antibody-drug conjugate. So the mindset that I’m encouraging is less worried about what’s going to happen later and more about what is the best therapy for my patient right now. And we’re seeing remarkable outcomes with these three modalities. In particular, recently with our bispecific antibodies, seeing how we can get that depth of response, especially in combination if the patient is CD38 naive. So we really have great options for our patients. So this is a good problem to have. Give your patient the best therapy now.
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