VIDEO: Quadruple therapy a major development in myeloma treatment

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For the last year, we have a few developments that are actually really exciting and that includes the use of quad based therapy with the implementation of Anti-CD38 based monoclonal antibodies, both Cetuximab and Daratumumab and frontline treatment for both transplant eligible and transplant non-eligible patients. Previously we used to use Anti-CD38 for eligible patient only, and now with the use of that in transplant non-eligible patients, we found improved disease control with improved progression-free survival as well as depth of response which got better with the addition of Anti-CD38 based antibodies.

So patients are now thought to be a quad eligible. That means if they're in a good shape, they will likely go to use this quad based therapy regardless of the transplant eligibility, especially if they're less than 80 years old. And I think that is exciting because that allow us access to those really good drugs that have low incidents of incidence of concerning side effects. For example, in the use of proteasome inhibitors there was concern of having peripheral neuropathy, which we don't see in the use of Anti-CD38 based antibodies. Other developments in the field of myeloma also include the use of PCMA based therapy.

BCMA is B-cell maturation antigen and it is a way for us to target the myeloma cell. So there are multiple sort of ways of targeting BCMA and we have few products approved for use at a later line, especially after four or more lines of therapy. But nowadays we have evidence, for example, of using cell-to-cell as a CAR T-cell therapy after one line of therapy to be more effective than the use of a triplet based regimen. And this is extremely important in patients with functionally high risk disease. This is a term that we use describing patients who may relapse quickly after a high dose chemotherapy and autologous stem cell transplantation.

And for this subset of patients, the use of upfront, early sort of CAR T-Cell therapy after one line of therapy, maybe more of interest. And I think lastly I would say we also are seeing the development of bispecific antibodies in general in myeloma. And we have so far three approved products to use commercially. We have few more in development. And this field of bispecific antibodies is always improving with a more limited duration use and also with better understanding of the side effects profile that happens with those agents.