Dr Battiwalla on Advancements in the Multiple Myeloma Treatment Paradigm

Minoo Battiwalla, MD, director, Blood Cancer Outcomes Research, Sarah Cannon Research Institute, discusses recent advancements in the multiple myeloma treatment paradigm.

Changes in the approach to multiple myeloma management over the past year are characterized by key advancements in induction therapy and a significant expansion of FDA indications for CAR T-cell therapies in this disease, Dr. Battiwalla begins.

One notable shift is the widespread adoption of quadruplet induction therapy for transplant-eligible multiple myeloma patients, Dr. Battiwalla states. Upfront use of this approach, as suggested by findings from the phase 2 GRIFFIN trial (NCT02874742) and subsequently confirmed by the phase 3 PERSEUS trial (NCT03710603), has been established as the standard of care for patients with transplant-eligible multiple myeloma, regardless of cytogenetic risk status, Dr. Battiwalla details. Additionally, there is now a recognized emphasis on using consolidation therapy post-transplant, which typically involves 2 cycles of the quadruplet regimen, he adds.

Another key development is the incorporation of CAR T-cell therapies, which were previously confined to the fifth-line setting, into earlier lines of treatment, Dr. Battiwalla continues. Idecabtagene vicleucel (ide-cel; Abecma) received FDA approval in April 2024 for the treatment of adult patients with relapsed/refractory multiple myeloma following 2 or more prior lines of therapy, including an immunomodulatory agent (IMiD), a proteasome inhibitor (PI), and an anti-CD38 monoclonal antibody. In the same month, ciltacabtagene autoleucel (cilta-cel; Carvykti) was approved by the FDA for patients previously exposed to 1 or more prior lines of therapy, including an IMiD or PI, and who are refractory to lenalidomide (Revlimid). Both regimens significantly improved median progression-free survival vs standard regimens, Battiwalla reports. Notably, the toxicity profiles of CAR T-cell therapies appear more manageable when used in earlier lines of therapy, likely due to lower disease burden compared to later-line settings, he says.

Overall, these advancements represent a shift in the treatment paradigm for multiple myeloma, offering more effective and innovative options for patients at various stages of the disease, Dr. Battiwalla concludes.