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IMS 2024 | Managing patients with triple-class exposed myeloma using combination therapies
P. Joy Ho, MBBS, DPhil, FRACP, FRCPA, FFSc(RCPA), Royal Prince Alfred Hospital & University of Sydney, Sydney, Australia, discusses treatment options for triple-class exposed patients with multiple myeloma (MM), highlighting that classes of agents which the patient has been exposed to in prior lines of therapy can be reused in different combinations to maintain their activity. Prof. Ho also mentions the potential of cereblon E3 ligase modulators (CELMoDs) in combination therapies for this patient population. This interview took place at the 21st International Myeloma Society (IMS) Annual Meeting, held in Rio de Janeiro, Brazil.
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Transcript
The first point to note is that sometimes it is possible to reuse agents, but in different combinations, and we still see some activity. Having said that, one of the crucial tenets of treating triple-class exposed patients is now the availability of T-cell redirectional therapies. So on that basis, since our talk was on the non-T-cell therapies, one can choose combinations that may include elements of classes that they’ve been exposed to before, but then combined with other classes...
The first point to note is that sometimes it is possible to reuse agents, but in different combinations, and we still see some activity. Having said that, one of the crucial tenets of treating triple-class exposed patients is now the availability of T-cell redirectional therapies. So on that basis, since our talk was on the non-T-cell therapies, one can choose combinations that may include elements of classes that they’ve been exposed to before, but then combined with other classes. So, for instance, it is possible to use a carfilzomib combination in someone who’s been refractory to bortezomib, for instance, and then combine it with the alternative anti-CD38 antibody, combine it with pomalidomide. Of course, there’s now data on the use of belantamab, and from the DREAMM-8 trial, there were approximately 25% anti-CD38 refractory patients, which gives us randomized trial data to make that choice. And even though they’re mainly from Phase I studies and Phase I/II studies in terms of the CELMoDs, I think there’s a lot of hope that they will also help in combinations currently with iberdomide with daratumumab or mezigdomide with carfilzomib, that they will be helpful in triple-class exposed patients.
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