The first day is kind of a beginner’s day, with a number of Continuing Medical Education (CME) courses/presentations. I went to two: The first was Championing the Care of Relapsed/Refractory Multiple Myeloma: Practical Strategies to Integrate Bispecific Antibodies, and it was presented by Drs. Ajai Chari and Amitra Krishnan. Here are some of its key points:
- Heavily pretreated relapsed/refractory (R/R) patients will continue to fail more and more drugs
- In the HORIZON study, there were three bispecific antibodies: linvoseltamab, Tecvayli (teclistamab), and Talvey (talquetamab) used, each in a different arm of the study. Patients were heavily pretreated relapsed-treated MM patients, yet, they still each had an overall response rate (ORR) of over 60%
- Oral and skin toxicities were higher with talquetamab, but the infection rate was lower. Both doctors agreed that patients must be warned about skin problems. Also dysgeusia (my new favorite word, means abnormal taste), weight loss, and (rarely) cerebellar ataxia (poor muscle coordination).
- They discussed how to choose between CAR T-cell therapy and bispecific antibodiess? Timing is very important. Dr. Chari said to consider the time from “brain to vein,” meaning the time when the doctor first thinks about putting a patient into the CAR T list to when the patient’s T cells are reinfused is long. So, the question is can the patient last long enough, or is their disease rapidly progressing? In the latter case, a bispecific antibody would be the better choice.
- There’s still much learning to be done about sequencing these new therapies. “More questions than answers,” said Dr. Chari.
- Management of key toxicities is extremely important. Clinicians must treat for cytokine release symptoms (CRS) as the first symptom. Also, infection management must be done at first onset, often giving IVIG as soon as treatment is started.
- “Bispecific antibodies will become as routine as Darazalex (daratumumab) now,” said Dr. Krishnan.
- Bispecifics and other MM drug combos are currently off-label.
Phew! It was an interesting discussion, and I was pleased that I understood so much. The next session was a bit harder, but I’ll tackle that report tomorrow. It was about Optimizing CD38 antibody-based triplet regimens for early relapse MM. For my fellow patients, you probably know that early relapse is a signal that your myeloma is showing itself to be high- risk. That sounds scary; and it is scary, but I was also impressed that so much energy is being put into drug development and clinical trials to learn how to successfully treat the high-risk patient.