IMS 2025 | Quadruplet regimens in transplant-ineligible NDMM: the new standard of care

So at the IMS 2025 in Toronto, I’ll be discussing the two, so in two sessions, I’ll be discussing the quadruplet-based regimen and particularly the isatuximab CD38 monoclonal antibody plus bortezomib, lenalidomide and dexamethasone quadruplet-based regimen in newly diagnosed myeloma in transplant-ineligible patients. And so discussing the ISA-VRd in the Sanofi Symposium, will also lead me to present the IRAKLIA data. So to start first with the symposium, what the symposium really will, I believe show and put into consideration for the audience is the thing that when you look at the data, it’s pretty clear that we should be giving the quadruplet-based regimen to as many patients as we could. Of course, in transplant-eligible patients, in transplant-ineligible patients, and of course, not to very frail patients for whom the safety profile is absolutely key because it participates massively to the survival. But for the rest of the patients, the quadruplet-based regimen should be the new standard of care, and we should not be treating patients with triplet-based regimen anymore. Mechanistically and so if you look at the data based on MRD, minimal residual disease, but also based on survival, based even I would say on cost because for many countries it is important. The quadruplet-based regimen when you have dexamethasone, lenalidomide and bortezomib that are generic drugs and the only costly drug is a monoclonal antibody CD38 targeting seems to be an extremely good ratio balance quality effect activity efficacy versus cost. And so we really demonstrate that in all the studies IMROZ indeed with isatuximab benefit our Phase III study with isatuximab and CEPHEUS with daratumumab all of the studies keep demonstrating it’s more than thousands of patients demonstrate that the quadruplet-based regimen is providing an extremely prolonged PFS probably 10 years. We don’t know yet. The median would be expected at 10 years. We don’t know yet because we don’t have this follow-up. IMROZ is about five, six years, CEPHEUS as well. BENEFIT is only two to three years follow-up. So we don’t have the 10 years follow-up, but we believe the median PFS will probably land about 10 years without transplant. Pretty safe. The first six months in IMROZ and CEPHEUS, we’re twice-weekly bortezomib in benefit, one year to 18 months bortezomib weekly. But for the rest, it’s only a combination of the CD38 and here isatuximab and lenalidomide, which is not completely safe, but honestly, very easy to manage if you’re convinced that this is the best for the patients. In IMROZ and CEPHEUS, we still don’t have overall survival, but we do believe when we look at the trends of the curves that we get there.

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