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IMS 2026 | Early use of BCMA-targeted therapies at first relapse in multiple myeloma
Joseph Mikhael, MD, MEd, FRCPC, FACP, Translational Genomics Research Institute (TGen), Phoenix, AZ and International Myeloma Foundation, Studio City, CA, discusses key treatment considerations for community oncologists managing patients with multiple myeloma at first relapse. He highlights the growing evidence supporting early use of BCMA-directed therapies, including CAR-T therapy, bispecific antibodies and antibody-drug conjugates (ADCs), rather than relying on traditional triplet regimens. This interview took place at the 23rd International Myeloma Society (IMS) Annual Meeting in Glasgow, UK.
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Transcript
You know, this is my experience in the United States because the majority of myeloma patients are treated in the community. The majority of those physicians practicing in the community spend little time in myeloma, perhaps five to seven percent of their time in myeloma. So it’s hard for them to keep up with all of these changes. So there are lots of lessons we would want to bring to the oncologists in the community...
You know, this is my experience in the United States because the majority of myeloma patients are treated in the community. The majority of those physicians practicing in the community spend little time in myeloma, perhaps five to seven percent of their time in myeloma. So it’s hard for them to keep up with all of these changes. So there are lots of lessons we would want to bring to the oncologists in the community. But perhaps the most important one is this notion of not saving the best for last. That these immunotherapies, CAR T-cell therapy, bispecific antibodies, antibody drug conjugates, have now moved into early relapse. And although we might find comfort in giving the triplets that we’re used to combining a CD38 antibody with an IMiD or a proteasome inhibitor with dexamethasone, we can do much better for our patients. There is no doubt we have seen phase three trial after phase three trial after phase three trial demonstrating the superiority of these immunotherapies over those traditional triplets. And so I would encourage them to say, why am I not giving a BCMA directed therapy at first relapse? Why am I not introducing CAR-T, or a bispecific antibody, or an antibody drug conjugate as early as possible in the disease course? Because these therapies will give patients deeper and more durable responses, and there will still be many options thereafter. We’re seeing a large proportion of patients now get their longest remission ever with these therapies and we want to make sure that we give our patients the best therapy possible.
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