Dr. Costa on Developing Later-Line Therapies for the Frontline Setting in Multiple Myeloma

Luciano J. Costa, MD, PhD, an associate professor of medicine in the Blood and Marrow Transplantation and Cell Therapy Program at the University of Alabama (UAB) Birmingham School of Medicine, and associate director for clinical research at the O’Neal Comprehensive Cancer Center at UAB, discusses the rationale to develop later-line therapies for use in the frontline setting in multiple myeloma.

Several therapies that have demonstrated efficacy in the relapsed/refractory multiple myeloma paradigm could have clinical utility in the frontline setting, says Costa. For example, CAR T-cell therapy may be a good up-front treatment option, particularly for high-risk patients with multiple myeloma who are identified early, Costa explains. Additionally, bispecific antibodies alone or in combinations may be a more scalable, off-the-shelf option for this patient population, Costa says.

Venetoclax (Venclexta) as a single agent or in combination with dexamethasone could have utility in the subset of patients with newly diagnosed multiple myeloma who have translocation 11;14, says Costa. Additionally, lower weekly dosing of selinexor (Xpovio) in combination with proteasome inhibitors could benefit high-risk patients with extramedullary disease or those who harbor 17p deletions, concludes Costa.