IMS 2026 | Barriers to accessing novel therapies at first relapse in multiple myeloma

A number of new therapies have entered our treatment armamentarium for first relapse in myeloma. These are great treatments. Generally, drugs targeting BCMA and more newer GPRC5D, especially bispecific antibodies, but also ADC antibodies and CAR T cells have really shown progression-free survival and also overall survival that is much better than with our traditional first relapse therapy. So these are really what we should now consider new drugs that we would ideally want to give patients in these early lines of treatment. But not everyone has access. Access can be a problem for patients for various reasons. Of course, we have a general difference in access across the globe, and low- and middle-income countries are very clearly disadvantaged here in terms of the sheer cost of care that these drugs entail and are just a general barrier of access. But also in higher income countries, there can be barriers to access. Healthcare systems may have to decide which treatments to pay for. For example, in public healthcare systems, they use a tool called health technology assessment to evaluate the drugs, but often for that they need data that really shows whether in that healthcare system the drug is likely to work and to do what it promises and the data is often lacking. So we really made a case in our session that it is very, very useful to collaborate together, for example, with national study groups or institutions like the IMWG or the UKMS to early on discuss what data is needed to facilitate access to these drugs. And then there are actually also very geographical factors, for example, such as distance to a CAR T-cell center. Can a patient reach this? Is this really a possibility or do they have the means to access treatment sites? For example, in the UK, this is called social deprivation. If patients are having a low income within a high income country, they might just not be able to access the same type of treatments because they also need to come frequently for, for example, IVIG infusions or they might encounter frequent infections which might just not be feasible to manage for them so there’s really a whole range of reasons why access can be limited but identifying them, understanding them is our very important step in improving them and together in a collaboration we stand a very good chance of making access much better than it is at the moment for patients.

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