IMS 2023 | How immunotherapies are changing the myeloma treatment landscape & future outlooks
Gordon Cook, MB ChB, PhD, FRCP(Glas), FRCPath, Leeds Teaching Hospitals NHS Trust, Leeds, UK, discusses whether immunotherapies might be brought forward into earlier lines of treatment for multiple myeloma and how this may change the treatment landscape. Prof. Cook also highlights the challenges of administering sequential immunotherapy and explains how alternating with non-immunotherapeutic approaches could mitigate these problems. This interview took place at the 20th International Myeloma Society (IMS) Annual Meeting, held in Athens, Greece.
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Transcript (edited for clarity)
There is a massive expansion in interest in immunotherapy. I’m an allografter by training so I’ve always believed in the immune approach from an allograft in myeloma, albeit it was relatively weak. I could never have imagined that we would find ourselves here, in the 2020s, talking about numerous immunotherapy agents driving the patient’s own immune system to attack myeloma, so it’s a very, very exciting period...
There is a massive expansion in interest in immunotherapy. I’m an allografter by training so I’ve always believed in the immune approach from an allograft in myeloma, albeit it was relatively weak. I could never have imagined that we would find ourselves here, in the 2020s, talking about numerous immunotherapy agents driving the patient’s own immune system to attack myeloma, so it’s a very, very exciting period. Most of these agents are starting in the triple-class refractory space, the advanced disease. Ultimately, my lab has got data that shows that immune profiling changes dramatically from diagnosis to the end stage. Therefore, it makes sense to bring those therapies into earlier lines of treatment. At present those studies are being done.
Let’s think beyond that: what if these studies prove that that’s a better space to use immunotherapies? In that setting, I think we then need to think about what we do post-immunotherapies. Do we do more immunotherapies? Those studies are being thought about and designed. Or do we see a paradigm shift? A lot of the drugs and strategies we use in first- and second-line, then become standard of care in third and fourth-line. All these things are possibilities. One thing is that we are probably not going get away with sequential immunotherapies, particularly T-cell engagers, because one of the limitations is that they exhaust the T-cell pool. It makes no sense, we might change the target to get around antigenic escape, but if the T-cells are tired, they’re still going to be tired. There may be ways of leap-frogging lines of treatment using non-immunotherapies. That’s where the current strategies we use may come into play, or the development of more targeted non-immunotherapy approaches that are in development that will come into clinical trials in due course. I think we will see a landscape where first-line will be immunotherapies, second-line will be non-immunotherapies, third-line immunotherapies, and so on. That’s what I would predict for the coming future.
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