Multiple Myeloma Management in 2021 - Episode 15
Paul G. Richardson, MD; Nina Shah, MD; David Siegel, MD, PhD; and Saad Z. Usmani, MD, provide closing thoughts and key takeaways on multiple myeloma from the 2020 ASH Virtual Meeting and future directions for disease management.
Paul G. Richardson, MD: I want to ask each of you for comments, but I’d also like to thank everyone for an incredibly rich and informative discussion. It’s been lovely. One of the advantages of Zoom is that you can do this in such a relaxed and interactive format. With that in mind, I wonder if I could get some final thoughts. Nina, can I start with you? What are your takeaways from ASH [American Society of Hematology Annual Meeting] and thoughts for 2021?
Nina Shah, MD: ASH was exciting, and I’m glad we were able to see so much data and not be running around dehydrated during the meeting. One of the things we took away, as I said on Twitter, is that BiTEs [bispecific T-cell engagers], bispecifics, were the homecoming queens crowned by the alumnus CAR [chimeric antigen receptor] T cell, because they really had a huge impact, and I think that’s where we’re going. We have a lot of good data in up-front [multiple] myeloma [MM] with triplet and quad therapy and transplant. It’s hard to beat that. Where I see this going is induction with quad, maybe transplant, and maybe some maintenance with antibody-based therapy. Then, first progression, CAR T or BiTE, and then what you haven’t used. Finally, GPRC5D or FCRH5, for example. There’s always going to be room for melflufen, selinexor, and all these new drugs. There will always be enough MM to go around. Overall, that was my takeaway from this year’s ASH.
Paul G. Richardson, MD: Yes, I concur. However, I think we’re going to have such a tailored approach, that I wouldn’t be surprised if we’re going to be mixing and matching. I’d love to ask Saad. You can give us your views on how you could see mixing or matching some of these ideas. One obvious example is, as we mentioned, melflufen. Is that going to be useful bridging therapy, for example, prior to a CAR T? This is just a thought for this concept of stemness. Saad, any takeaways?
Saad Z. Usmani, MD: Nina hit the nail on the head with her summary. The point I’d like to make is that we already utilize other alkylators to control disease while we’re trying to get patients to CAR T-cell therapy. One of the key things that was different between the early bb2121 [idecabtagene vicleucel] experience vs the latter 1 was how frequently bridging therapy was being utilized subsequently as we got more comfortable in using other therapies, including cytotoxics and alkylators in that setting. It would be a reasonable thing to explore. Yes, David, I said, “reasonable thing to explore,” and I did not say “go and give melflufen to everyone before CAR T-cell therapy.”
Paul G. Richardson, MD: Let’s move beyond melflufen. David, give us takeaways. Obviously, it was an amazing ASH given the challenges. I think MM was 1 of the most heavily represented hematologic malignancies at the meeting. We were able to do it despite the unbelievable challenges of 2020. Your perspective, David?
David Siegel, MD, PhD: To add 1 step, this was a very exciting ASH meeting because we are just beginning to understand some new technologies that over the next couple of years are going to be much more developed. As we talk about treating asymptomatic MM and things like that, to start to use some of these special therapies in that patient population. Perhaps where we will be using BiTEs—a proprietary term for these T-cell engagers—maybe in patients with relatively healthy immune systems who are clearly going to progress to myeloma, and this will be a niche to address these things.
We just heard about a whole bunch of very exciting new platforms that we’re just starting to get comfortable with and a whole bunch of additional platforms that are following close behind. So to commit patients to old technologies today, I wouldn’t do it because there’s so much interesting stuff. We want to preserve the naïveté of the MM so that these scientists who are providing us with these new platforms can really find the right thing for the right patient. It’s going to be an amazing decade. It’s not starting so amazing perhaps, but it’s going to be an amazing decade for evolution of myeloma care.
Paul G. Richardson, MD: That’s a lovely note of optimism, especially given that we are facing probably the worst time I’ve seen in my lifetime, in every way. I say that as a Brit with the privilege to live in the United States. I can only say that this country will go on to much greater things, because it deserves so much better in every way. I look forward to that as we go forward in the spirit of ongoing joy of working in myeloma. It is a joy, and it’s a privilege to serve our patients, and there is the joy of the forward momentum. We are so fortunate to have not only such amazing science but also an amazing community of MM doctors who I feel it’s the greatest privilege to work with. Above all is the privilege of helping our patients and families.
I want to say an enormous thank-you to everyone. It’s been lovely to spend time together. I’m especially grateful to our viewing audience, and we really hope that you found this OncLive® Peer Exchange® discussion useful and informative and above all that you’re hopeful for the future. Thank you, everyone.
David Siegel, MD, PhD:Thank you.
Nina Shah, MD: Thanks for having us.
Transcript edited for clarity.