EMN 2021 | Recommendations for the management of myeloma
Michel Delforge, MD, PhD, University of Leuven, Leuven, Belgium, outlines the key developments in the field of multiple myeloma treatment at EMN 2021, comparing therapies for transplant-eligible and non transplant-eligible patients. Prof. Delforge discusses the use of the monoclonal antibody therapy daratumumab in different combinations, as well as the role of lenalidomide, and alternative therapies for lenalidomide-refractory patients. Finally, Prof. Delforge talks on the use of novel therapies such as chimeric antigen receptor T-cell (CAR-T) therapy. This interview took place during the 2021 European Myeloma Network (EMN) congress.
Transcript (edited for clarity)
The therapeutic field of multiple myeloma is evolving very rapid, and of course this is in the benefit of patients, but it’s also complicating daily life for myeloma physicians. But, generally speaking, we see that in the treatment of newly diagnosed patients for the transplant-eligible group, we see now the introduction of anti-CD38 monoclonal antibodies like daratumumab up in the dara-VTd regimen, and in a few years from now in the dara-VRd regimen...
The therapeutic field of multiple myeloma is evolving very rapid, and of course this is in the benefit of patients, but it’s also complicating daily life for myeloma physicians. But, generally speaking, we see that in the treatment of newly diagnosed patients for the transplant-eligible group, we see now the introduction of anti-CD38 monoclonal antibodies like daratumumab up in the dara-VTd regimen, and in a few years from now in the dara-VRd regimen.
For the non-transplant eligible newly diagnosed patients, we see that the combination of dara-Rd is really the most effective regimen, and that benefits like all patients. For relapsing patients it becomes more complicated because first of all, we see now at first relapse, that more and more patients are lenalidomide-refractory. So, very potent lenalidomide-based combinations like dara-len-dex, they become, or they will become now not the first choice for a growing group of len-refractory patients.
So here we have to rely on other options like pomalidomide-based regimens or carfilzomib-based regimens. And then, for patients with later relapse, there’s now a whole new field of advanced immunotherapeutics like the antibody-drug conjugates. There are the CAR T-cells that are close to being approved. There are very interesting data with T-cell engagers. So, these drugs, these agents, they will also revolutionize the treatment approach of later relapses. But, it also confronts us with specific challenges because all these different agents are not at the same time available in all the different countries. Not all combinations have been tested prospectively in Phase III studies, and they are not all registered in the different countries.
And finally, we have in relapsed myeloma always think ahead, and if we make a choice for a particular treatment regimen, we also have to think how does this impact the future treatment at the next relapse? It’s clear that these treatments need to be tailored also according to patient and disease characteristics. So, in summary, it’s an extremely interesting field, but it moves very rapidly and it requires really very good collaboration, interaction, to get the most benefit of this therapeutic progress.
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Disclosures
Michel Delforge, MD, PhD, has participated in advisory boards for Amgen, Celgene-BMS, GSK, Janssen, Takeda and Sanofi; and has received research grants from Amgen, Celgene, Janssen, Takeda and Sanofi.
