How Anti–CD-38 Antibodies Are Changing the Standard of Myeloma Care

At a recent Institute for Value-Based Medicine® event in Houston, Hans Lee, MD, director of multiple myeloma clinical research, associate professor in the Department of Lymphoma/Myeloma at the University of Texas MD Anderson Cancer Center, shared his insights on the evolving treatment pathways for multiple myeloma. Here, he highlights the transformative impact of bispecific antibodies and chimeric antigen receptor (CAR) T-cell therapies on relapsed/refractory (R/R) multiple myeloma and discusses the incorporation of anti–CD-38 monoclonal antibodies into frontline therapy.

This transcript has been lightly edited for clarity.

Transcript

How has integrating bispecific antibodies and CAR T-cell therapies altered treatment sequencing for R/R multiple myeloma?

Bispecific T-cell antibodies and CAR T therapies have really transformed the treatment landscape for relapsed/refractory multiple myeloma over the last 2 to 3 years or so. Before their regulatory pools, we had very limited options for treatment of what we call triple class refractory multiple myeloma—these are patients who are refractory to IMiDs [immunomodulatory drugs], proteasome inhibitors, anti–CD-38 monoclonal antibodies. And the advent of bispecific antibodies and CAR T therapies have really provided a very efficacious therapy with not only high overall response rates, but durable responses for this challenging patient population to treat.

How do you see anti–CD-38 monoclonal antibodies changing the standard of care in multiple myeloma?

Anti–CD-38 monoclonal antibodies like daratumumab and isatuximab have really transformed the landscape for the treatment of multiple myeloma, both in the relapsed setting [and] the newly diagnosed setting. And I think one of the most exciting things recently in the last couple years has been the incorporation of anti–CD-38 monoclonal antibodies in frontline therapy. Now, we have multiple studies showing the addition of anti–CD-38 monoclonal antibodies with the backbone of bortezomib/lenalidomide/dexamethasone, or even carfilzomib/dexamethasone really adds benefit in terms of not only MRD-negative rates, but also in some studies, progression-free survival as well.

I think most of us would consider that the standard of care for newly diagnosed multiple myeloma should incorporate an anti–CD-38 monoclonal antibody plus a protease inhibitor [and] IMiD backbone as standard of care for both transplant-eligible and even transplant-ineligible patients who are fit to receive a quadruple-based therapy.