IMS 2025 | The treatment landscape for patients with multiple myeloma at first relapse

In any event, my remit for the oral session that we were a part of was to really frame for our audience the challenges of the first relapse landscape and how this is a rapidly evolving space. Because obviously as we have quadruplet therapies now becoming standards of care for newly diagnosed patients, when those treatments ultimately fail our patients, what do we have? And so what I sought to do was help people understand that unfortunately, despite all the advances, we still see patients inevitably relapse after first-line therapy, and our choice of treatment at that time becomes very important in improving outcome. And so what I focused on was the construct of a new target, a new mode of action, and in that context, we discussed the role of targeting BCMA, and in particular, what we have currently approved in first relapse in that setting. Now, globally, belantamab mafodotin in combination with either bortezomib or pomalidomide has been recently approved outside of the United States for this particular group of patients. And our discussion really focused on the potential value of that approach. We also discussed the CAR-T therapies that are currently approved in first relapse. And this is specifically cilta-cel based on the results of CARTITUDE-4. And my goal really there was to explain, whilst that’s a remarkable platform, obviously CAR T therapy is a rather selected approach to treatment. And whilst its outcomes are miraculous, there are significant toxicities that we can encounter, including life-threatening ones. And so in that context, we need to be very thoughtful about treatment choices. I also sought to emphasize the fact that revisiting the same classes of drugs in the setting of early relapse now with quadruplet therapies now becoming a standard care has challenges. Most importantly, that the outcomes are perhaps less effective than we would hope for. And so these new mechanisms of action are very important. So it set up really the discussion for my colleagues in the panel to really frame the differences between CAR-T therapy, antibody drug conjugates, and in particular belantamab mafodotin in combination with other drugs. And what was so exciting was to see the real benefit of belantamab mafodotin combined with other drugs and its relatively important ease of administration and accessibility for patients, realizing that we’ve really figured out the ocular toxicity, managed that so much better. So, it’s more of a nuisance than a barrier to successful treatment. And to look at the outcomes, which are remarkable, progression-free survival estimates of the median of three and a half years and clear survival benefit to second line therapy. And when one thinks of CAR-T, in particular cilta-cel, we see even more impressive results, but not dissimilar. For example, progression-free survival gains of up to three and a half to four years. And obviously, it’s a one-and-done type of phenomenon. But the challenge, of course, for CAR-T is accessibility, specialized requirements for its use. And I think most important, and this was the, I think, a really critical part of the conversation is that there are rare but potentially life-threatening toxicities. So with that in mind, it’s wonderful to have options to present to our patients and in particular to see the promise of belantamab mafodotin in particular in combination with other drugs providing benefit for our patients in that setting.

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