Addressing Unmet Needs in Multiple Myeloma

Amrita Krishnan, MD, FACP: We’ve been very excited about all the progress we’ve made in myeloma, but we also need to take a step back and recognize that there are populations that still need to be addressed, and they’re very challenging populations. One of them is patients who have CNS relapse of their myeloma, and that is something that’s very frustrating to treating physicians, because we have all these drugs and we use them, we treat patients, they respond, but now they’re multiply relapsed, and many of them relapse in the CNS. We’re seeing it more and more. All of those patients are excluded from clinical trials, and we have very little to offer those patients beyond radiation as our old standby. And so, we are desperately looking for options for those types of patients.

Patients with renal failure still remain a challenge. The good news is, the drugs that we have, we can use many for renal failure. Some of them require dose adjustments. Many of them don’t. But, again, once you’ve cycled through all those approved drugs, those patients are excluded from clinical trials, so that becomes a big challenge for patients. And the other challenge is patients with plasma cell leukemia—a rare disease but a disease that has very poor outcomes in many patients and not addressed completely by clinical trials—again, a group that we really do need to intervene in to get the same results that we see with our other myeloma patients and patients who have high-risk myelomas, RSS stage 3, biallelic 17p deletion. They’re part of clinical trials, but those are the groups that I think we need to focus on even more. And that’s a group where, for example, immunotherapy and using CAR T cells earlier in their course of treatment may be very impactful. And we’re looking forward to clinical trials addressing that population.