VIDEO: Logistical issues complicate relapsed/refractory myeloma treatment

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So there are a lot of treatments, but they come with their own nuances, for instance, CAR T-cells, there's a lot of logistical issues. You have to collect, wait for manufacturing, treat. CAR T-cells are also available primarily in larger academic centers or large-volume centers, so limited availability. And there are some unique toxicities that we need to monitor for, manage with these immunotherapies. So I think one challenge would be for patients is to be able to access these treatments and to be able to go to the centers where these treatments available.

Cost is another big challenge. Making sure that these treatments are readily available for the most number of patients that need them remains I think the challenge. So access and cost for these new treatments is a unique challenge, such that several groups have now shown that as patients get more and more relapse, fewer and fewer patients get treated either because of toxicities, lack of access, other reasons. So I think one big challenge would be we have these effective treatments, can we make them available for all of the patients that need them? Toxicity management is another challenge. These are effective treatments, but again, they have their set of unique or even serious toxicities. How do we mitigate that? How do we prevent those toxicities? Is another challenge.

And then lastly, I think as we get more effective treatments, can we limit the duration of treatments? So the paradigm in myeloma has been, this is the incurable cancer so we continue treatments indefinitely. Can we do time-bound treatments and provide patients with treatment-free intervals where they can have a good quality of life, no side effects, and still maintain the high efficacy, I think is the other challenge.