My Treatment Approach: Bispecifics in Multiple Myeloma: Translating Evidence to Clinical Practice - Episode 6

Multiple Myeloma: Sequencing Novel Bispecific and CAR T-Cell Therapies


In light of emerging bispecific and CAR T-cell therapies in multiple myeloma, experts consider how they might optimally sequence treatment.


Adriana Rossi, MD: I think, as in academia, whenever patients progress on a clinical trial, if they still have the performance status and can meet eligibility, we put them on further studies. We’ve certainly had a number of patients who’ve gone on to either other bispecifics or CAR [chimeric antigen receptor] T-cell therapies. What's been your experience on salvaging them once they relapse after the bispecific?

Luciano Costa, MD: I totally agree with you, Dr Rossi. I think at this point it would be naive of us to be too prescriptive of what the ideal sequence or ideal path is. Those things are going to be clarified only through larger data sets like your team did at Mount Sinai, and having those large observational cohorts where you describe how patients did after exiting one experimental agent and exploring other mechanisms of action. The important thing that makes me very comfortable pursuing whatever path is innovative and in front of us is that the benchmark for those patients is horrible. For patients with triple-class refractorymultiple myeloma, you give whatever combination of agents you have; the response rates are not greater than 20%, 30%. The survival is measured in a few months and the responses are very short-lasting. When you have agents with 70%, in the case of CAR T cells, 80%, 90% response rate, there’s certainly one or more steps above what is currently available. Just like you said, those patients, to the extent possible, go from trial to trial, as long as they, of course, maintain eligibility. There’s a lot of discussion about people willing to participate in clinical trials. What I find most reassuring is, oftentimes, we have difficulty explaining to a patient what to expect on the first trial. But once they overcome some of the misconceptions and once the patient participates, the second or third trial is almost never a problem. They see for themselves that it’s a win-win and, in this case, brings them options they wouldn’t have otherwise. We don’t follow any preset plan. We try to rotate the mechanism of action and look for the best option or the most promising option with a new mechanism of action available to the patient at that particular time.

Transcript edited for clarity.