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IMS 2026 | Barriers to using BCMA-targeted therapies at first relapse in multiple myeloma
Joseph Mikhael, MD, MEd, FRCPC, FACP, Translational Genomics Research Institute (TGen), Phoenix, AZ and International Myeloma Foundation, Studio City, CA, discusses barriers to using BCMA-targeted therapies at first relapse in multiple myeloma. He highlights regulatory and geographic access, provider familiarity and the need to shift toward using highly effective immunotherapies earlier in the disease course. This interview took place at the 23rd International Myeloma Society (IMS) Annual Meeting in Glasgow, UK.
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Transcript
You know, there are really several reasons why we see BCMA therapies not being used at first relapse. And often it’s a multi-faceted problem, needs a multi-faceted solution. But I would say that the top three are as follows. One, in fact, there are still several jurisdictions where they’re not fully approved. Even in the US, we can’t use antibody drug conjugates until someone has had two prior lines of therapy...
You know, there are really several reasons why we see BCMA therapies not being used at first relapse. And often it’s a multi-faceted problem, needs a multi-faceted solution. But I would say that the top three are as follows. One, in fact, there are still several jurisdictions where they’re not fully approved. Even in the US, we can’t use antibody drug conjugates until someone has had two prior lines of therapy. Many countries don’t have access just from an approval standpoint for CAR T-cell therapy or bispecific antibodies. So as the evidence is emerging, we need to ensure that people see that these therapies are clearly better than the triplets that we’ve been historically using and should have the approval. Number two, there’s general access to these therapies, meaning the geographic barriers that keep people, the misunderstanding of the data from the primary care or the oncology providers that don’t know yet. There’s always a period of time that it takes for the science to come and bring us what’s true for it to pragmatically happen in the community. And then thirdly, I think really there is just a need for a change of thinking around how we treat multiple myeloma. For so long, there was still this thinking of, oh, I’m going to save the more important therapies or the better therapies for later. But as I say, don’t save the best for last. Saving the best for last may be great for a romantic movie, but it is not good for multiple myeloma. So it’s sort of a shift in the way we think about multiple myeloma that we want to give our patient the best therapy available to them. And as I’ve often said, and I’ve had the privilege of sharing here at the IMS meeting, that if we look at what we give to a patient at frontline therapy and first relapse, those two things together are perhaps more prognostic in the life of a patient than anything else. So what we select at first relapse is absolutely critical to the survival quantity and quality of life of that patient.
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