BSH 2022 | The evolving treatment landscape in multiple myeloma & ongoing research
Guy Pratt, MD, FRCP, FRCPath, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK, discusses key advances in the management of multiple myeloma. In recent years, the introduction of anti-BCMA monoclonal antibodies and chimeric antigen receptor T-cell (CAR-T) therapy has revolutionized the treatment landscape of multiple myeloma. Prof. Pratt also mentions the approval of the quadruplet combination of daratumumab, bortezomib, thalidomide and dexamethasone (D-VTd) in the UK. Moving forward, Prof. Pratt highlights various areas of ongoing research in multiple myeloma, including treatment sequencing, risk-adapted therapy in young patients, dose adjustments and frailty assessment in elderly patients, which is currently evaluated in the FiTNEss trial (NCT03720041), and the potential role of measurable residual disease (MRD) as a clinical endpoint, which is currently being assessed in the RADAR trial (ISRCTN46841867; UK-MRA Myeloma XV).
Transcript (edited for clarity)
So the treatment of myeloma is changing rapidly all the time. Lots of new, novel agents that are appearing. I think in the UK, what we’re allowed to do is very dependent on access to drugs. So it does differ in the UK from North America. The main excitement I think in myeloma is monoclonal antibody therapies, particularly anti-BCMA targets and CAR-T cell therapy at the moment.
And certainly monoclonal antibody therapies with daratumumab, for example, have moved up to the frontline...
So the treatment of myeloma is changing rapidly all the time. Lots of new, novel agents that are appearing. I think in the UK, what we’re allowed to do is very dependent on access to drugs. So it does differ in the UK from North America. The main excitement I think in myeloma is monoclonal antibody therapies, particularly anti-BCMA targets and CAR-T cell therapy at the moment.
And certainly monoclonal antibody therapies with daratumumab, for example, have moved up to the frontline. Recent approval in the UK for VTD dara, which is a great combination. And also we’re moving more to continuous therapies now for all patients, but there is still a big question about how to sequence agents best. And the big questions that are coming out now, I think, are in the elderly population, how we should be dose adjusting, frailty assessments. And then in younger patients identifying high-risk groups and whether we should be treating those differently. And after treatment monitoring with minimal residual disease, and whether we should be using that as a clinical endpoint. We know that it’s very prognostic, but whether we should be using that to change treatment is unclear at the moment. And I think the upfront trials in the UK, like RADAR is trying to address that. And the FiTNEss trial is trying to address the issue of frailty assessments in elderly patients.
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