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SOHO Italy 2025 | The current standard approach to myeloma treatment in Brazil
Angelo Maiolino, MD, PhD, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil, comments on the current standard approach to multiple myeloma (MM) treatment in Brazil, noting that the private sector follows a similar approach to the US and Europe, with novel agents and therapies available for patients. In contrast, patients in the public sector do not have access to many newer therapies, which must be addressed. Despite this discrepancy, Prof. Maiolino emphasizes the significant progress made in myeloma treatment over the past few decades, with a significant improvement in patients’ median overall survival (OS). This interview took place at the SOHO Italy Annual Conference 2025 in Rome, Italy.
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Transcript
The standard of care for the private is almost the same as in the US and Europe. So we have daratumumab for first-line treatment. It’s approved for the eligible transplanted patient. DaraVTd and DaraVRd is approved. Lenalidomide as maintenance is also approved. And for the relapsed scenario, you have approved almost all drugs, including the bispecifics, teclistamab, elranatamab, and talquetamab, and also the CAR-T, the ciltacabtagene autoleucel, is approved in Brazil...
The standard of care for the private is almost the same as in the US and Europe. So we have daratumumab for first-line treatment. It’s approved for the eligible transplanted patient. DaraVTd and DaraVRd is approved. Lenalidomide as maintenance is also approved. And for the relapsed scenario, you have approved almost all drugs, including the bispecifics, teclistamab, elranatamab, and talquetamab, and also the CAR-T, the ciltacabtagene autoleucel, is approved in Brazil. And unfortunately for the public, as I mentioned, it is not yet approved, lenalidomide, we hope to approve this year.
So in the public sector, the induction therapy is normally VTd or VCd followed by autologous stem cell transplantation when the patient is eligible for autologous stem cell transplantation. So I think that will be critical to approve for the public, lenalidomide, and then in another moment, daratumumab. Carfilzomib is approved for the public also, but it’s not yet reimbursed by the Ministry of Health.
So you have different unbalanced scenarios between the two systems. But in my point of view, I’m the president of the Brazilian Society of Hematology nowadays, so you are really committed to this issue of drug access. Multiple myeloma is a totally different scenario nowadays. When I started to treat multiple myeloma a long time ago, I had only melphalan, cyclophosphamide, and polychemotherapy. And the median overall survival was inferior to three years, less than three years. And now, at least for the standard-risk patients, the overall survival is 10 to 15 years. So it’s a totally different scenario.
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