Institution: Sylvester Comprehensive Cancer Center ASCO 2025 | Trends in the evolving myeloma treatment landscape: observations from ASCO 2025

At ASCO 2025, there were a lot of discussions that were brought up, as always. I was the fourth presenter in the first session focusing on newly diagnosed multiple myeloma at this ASCO 2025. I was sitting, listening to the other speakers before me, and I noticed that three out of four presentations in that same session included carfilzomib lenalidomide dexamethasone and only one included bortezomib lenalidomide dexamethasone and to me that was an observation that the field has now finally arrived at the same conclusion that we have arrived for a long time. 

We’ve worked on carfilzomib for almost 15 years and I think the field for a long time were questioning whether it could be given, if it was safe, there were discussions whether this is a cardiovascularly toxic drug. In our hands, we have always been very cautious. We have done echo and EKGs of every patient. We have never treated patients with underlying cardiovascular disease. We have taken out patients that had abnormalities with echoes and EKG. Also, we have been very cautious with fluid. We have given minimal IV fluid. We only give 250 milliliter of IV saline before cycle one, day one, day eight, and day 15. And then we don’t do more IV fluid. And we also always give oral factor Xa inhibitor to prevent anticoagulation, prevent hypocoagulation. So we give, for example, rivaroxaban 10 milligram once a day. We would never give just aspirin. And seeing how the other studies now are reporting out of ASCO, they seem to have implemented this minimal IV fluid. They also seem to have implemented the anticoagulation approaches. And you see very few cardiovascular events and very few thromboembolic events. So that really made me happy to see how the field has come around because it is a very effective drug. It’s not for everyone. For old or frail, or patients with cardiovascular disease is not a good option. And there were presentations showing how bortezomib could have up to 50% of patients suffering from peripheral neuropathy, which I think is quite severe, actually. It was really hugely underinterpreted in the past. 

I should also say that other trends that I spotted is the use of antibodies. In that session, I mentioned two of the presentations used the CD38-targeted antibody isatuximab, and two of them used the CD38-targeted antibody daratumumab. So all of them used CD38-targeted antibodies. So that’s an observation. 

And lastly, there were a couple of presentations that really challenged the use of chemotherapy with so-called transplantation. The MIDAS study from France showed that in the standard risk patient, the transplant didn’t add anything. And they also showed in high-risk patients that double transplant had absolutely no role. And they had not yet included a third arm that maybe even high-risk patients, maybe transplant doesn’t necessarily always have a role. They mentioned they’re going to explore that in a future study. So that’s a big step forward. 

So the field is moving for more effective combination therapy with antibodies, challenging the role of chemotherapy and so-called transplant, and also integrating MRD negativity in all these studies. So these were observations I made from ASCO 2025.

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