ASH 2021 | Is treatment discontinuation feasible for patients with myeloma with deep and durable responses?
Martin Kaiser, MD, FRCP, FRCPath, The Royal Marsden NHS Foundation Trust, London, UK, comments on the possibility of treatment breaks or treatment discontinuation for patients with multiple myeloma who achieve deep responses to their treatment. Several highly active novel therapies are available that can lead to deep and durable responses, such as monoclonal antibodies and bispecific T-cell engagers, raising the question of whether or not discontinuation is an option. Dr Kaiser highlights data from the MASTER trial (NCT03224507) which investigated this question and showed that patients with ultra-high-risk disease tended to relapse early despite achieving deep remissions, suggesting risk may need to be factored into decision making. This interview took place at the 63rd ASH Annual Meeting and Exposition congress in Atlanta, GA.
Transcript (edited for clarity)
It is currently an open question as to whether some patients can potentially discontinue therapies or have treatment breaks with the novel therapies, such as antibody therapies, T-cell engagers and such therapies that are really leading to deep responses. Some treatments are already being delivered that way. So the CAR-T cell therapies, for example, are predominantly being developed so that the patient gets a one off treatment and then has a treatment-free phase...
It is currently an open question as to whether some patients can potentially discontinue therapies or have treatment breaks with the novel therapies, such as antibody therapies, T-cell engagers and such therapies that are really leading to deep responses. Some treatments are already being delivered that way. So the CAR-T cell therapies, for example, are predominantly being developed so that the patient gets a one off treatment and then has a treatment-free phase. And of course the outcomes will need to emerge over the coming years as to how effective that is. It looks very promising in the current trials that have been read out, but for many patients there may be a mixed answer to that question in terms of the nature of their disease. So we are seeing now data emerge, for example, here at this year’s ASH. Very impressive data from the MASTER trial from Luciano Costa and his group that investigated that question, whether patients that have achieved a very deep response can potentially, and prolonged one, can potentially discontinue therapy.
And it seems to be emerging that those patients that have ultra-high-risk disease, so where there are two or more abnormal and high-risk, genetic lesions still tend to relapse early, even if they have reached a very good response and have maintained it for some time. So, we are also feeling, and this is how the clinical development program in the UK is currently designed that maybe we need to take risk into account when we make the decision as to whether we offer a patient a treatment-free time.
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