Panelists discuss how emerging therapies like CAR T cells and bispecific antibodies may transform frontline treatment by potentially replacing transplant or changing induction regimens, while considering the cost implications and need for sustainable care models.
This segment explores emerging therapies and strategies on the horizon for frontline treatment of transplant-eligible multiple myeloma patients and discusses how these innovations will transform the treatment landscape. The discussion divides emerging approaches into 2 main categories: CAR T-cell therapies and bispecific antibodies. CAR T therapies present the intriguing possibility of replacing autologous transplant, with ongoing clinical trials investigating this approach in both newly diagnosed settings and first/third relapse scenarios, potentially revolutionizing the treatment paradigm.
Bispecific antibodies offer opportunities to modify induction therapy by incorporating anti–B-cell maturation antigen agents either as monotherapy or in combination with anti-CD38 antibodies or immunomodulatory drugs. These approaches raise questions about optimal sequencing and combination strategies, including potential consolidation periods following transplant or CAR T therapy. The challenge lies in integrating these effective but mechanistically different agents into existing treatment frameworks while maintaining safety and deliverability standards established with current 4-drug regimens.
The implementation of these emerging therapies requires careful consideration of safety profiles, cost implications, and health care delivery models. While current quadruple regimens offer predictable toxicity profiles and ease of delivery, bispecific antibodies and cellular therapies introduce new adverse effect patterns, particularly infection risks, that must be understood before frontline implementation. The discussion emphasizes the need for sustainable treatment models that can accommodate higher upfront costs while potentially reducing long-term expenses through treatment-free intervals, representing a paradigm shift from continuous maintenance to finite treatment duration approaches in multiple myeloma care.
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July 7th 2025Tyler Sandahl, PharmD, a clinical pharmacist at Mayo Clinic, discussed the complexities of alternative payment models for chimeric antigen receptor T-cell and bispecific therapies and the need for improved data sharing in cancer care.
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