Treatment Duration and Emerging Strategies in Multiple Myeloma

Dr. Hans Lee and Dr. Prashant Kapoor discuss the evolving role of treatment duration and de-escalation in multiple myeloma, particularly for patients who achieve deep and sustained responses. Dr. Kapoor reviews evidence challenging indefinite treatment, including the MASTER trial and the second randomization of the ENDURANCE trial, and discusses how MRD status may help inform future approaches to treatment discontinuation or fixed-duration therapy. The conversation then turns to emerging data on incorporating BCMA-directed bispecific antibodies into frontline and maintenance strategies. Dr. Kapoor highlights preliminary findings from the MajesTEC-5 study, which evaluated teclistamab-based combinations in newly diagnosed, transplant-eligible multiple myeloma, including high rates of deep MRD-negative responses without compromising stem cell collection. He also discusses MajesTEC-4 data evaluating teclistamab in the post-transplant maintenance setting, where treatment was administered for a finite duration. The experts consider how increasingly effective bispecific and CAR T-cell therapies may support finite-duration treatment, treatment-free intervals, and potentially retreatment with the same therapy.