Treatment Selection and Sequencing in Relapsed/Refractory Multiple Myeloma

Dr. Hans Lee and Dr. Douglas Sborov discuss how clinicians conceptualize the three major BCMA-directed treatment approaches in relapsed/refractory multiple myeloma: CAR T-cell therapy, bispecific antibodies, and antibody-drug conjugates. Dr. Sborov distinguishes the immune-dependent mechanisms of CAR T-cell therapy and bispecific antibodies from the direct cytotoxic approach of antibody-drug conjugates. He emphasizes that treatment selection should be individualized based on the characteristics and preferences of each patient. The panel also considers differences in administration, including the single-infusion approach of CAR T-cell therapy compared with ongoing treatment with bispecific antibodies and antibody-drug conjugates. Dr. Sborov highlights the distinct toxicity profiles associated with each modality, including cytokine release syndrome and neurotoxicity with CAR T-cell therapy, infections with bispecific antibodies, and ocular toxicities with antibody-drug conjugates. The discussion concludes by emphasizing that multiple BCMA-directed options may be used across a patient’s treatment course, making sequencing an important consideration.