IMS 2025 | Isatuximab plus quadruplet regimens in transplant-eligible and transplant-ineligible myeloma

There is an ongoing revolution in frontline treatment of multiple myeloma in which isatuximab, a new generation anti-CD38 monoclonal antibody, is going to become the new backbone in both transplant eligible and transplant ineligible patients. We have seen recently results from GMMG clinical trials in transplant eligible and IMROZ in transplant ineligible patients in which isatuximab is combined with VRd, bortezomib and lenalidomide dexamethasone. There is a new ambition not only to obtain a disease control but to obtain an optimal response which correlates with the deepest responses possible. MRD negativity became the new end point. We wanted to obtain the deepest responses possible that correlate with the best long-term outcomes and potentially with the treatment-free remission according to a sustained MRD during the time. These quadruplets will become the new standard of care together with dara-VRd in transplant eligible PERSEUS and Dara-VRd in transplant eligible CEPHEUS. And I think that we can, the new revolution is that we can use these drugs, these quadruplets also in elderly population, not so fit with some comorbidities according to a wonderful tolerability, to a wonderful adherence. And in this moment, isatuximab, we know that it’s administered intravenously, even if we have the possibility for a fast injection according to the literature data, we will go to speed up the administration thanks to OBI that we have seen in both IRAKLIA and IZALCO clinical trials in combination with pomalidomide and carfilzomib, but we have seen that this tool is really fast, safe with a great improvement in quality of life from the patient perspective, but also great satisfaction from caregivers and healthcare staff. So I think that in the next future, the use of this quadruplet will be potentiated in terms of patient adherence by the subcutaneous administration of the drug. And we have seen that this is possible to be administered also from domestic administration, as we have seen in a sub-analysis that we have presented here in Toronto 2023, IMS. I think that Isatuximab is a potent drug with good tolerability and really fast response. So I think that this can be potentially one future backbone for both frontline and relapsed and refractory settings.

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