Surbhi Sidana, MD

Dr. Saad Usmani reviews key findings from the phase 3 CARTITUDE-4 trial and discusses the growing role of ciltacabtagene autoleucel (cilta-cel) in patients with second-line and earlier-relapse relapsed/refractory multiple myeloma. The discussion highlights the study population, including patients with lenalidomide-refractory disease and high-risk clinical features, as well as the significant progression-free survival benefit observed with BCMA-directed CAR T-cell therapy compared with standard triplet regimens. Dr. Usmani and the panel examine the depth and durability of response, including high rates of complete response and sustained MRD negativity, and discuss the concept of treatment-free remission as a unique advantage of CAR T-cell therapy. Faculty also explore practical considerations such as patient selection, manufacturing timelines, bridging therapy, disease burden control, and quality-of-life outcomes. The conversation further addresses important safety considerations, including cytokine release syndrome, neurotoxicity, Parkinsonism-like events, immune effector cell-associated enterocolitis, access challenges, and the logistical barriers associated with delivering CAR T-cell therapy in real-world multiple myeloma practice.

Dr. Thomas Martin opens this Cancer Network FACE-OFF program by introducing a debate-style discussion focused on one of the most rapidly evolving areas in relapsed/refractory multiple myeloma: treatment selection between BCMA-directed CAR T-cell therapy and bispecific antibody-based approaches in second-line and earlier-relapse disease. He outlines the unique format of the program, which combines clinical data review, expert debate, and case-based discussion to explore real-world treatment decision-making. Dr. Martin introduces Team Myeloma Mavericks, led by Dr. Saad Usmani and featuring Dr. Surbhi Sidana and Dr. Gurbakhash Kaur, and Team Myeloma Masters, led by Dr. Peter Voorhees with Dr. Amrita Krishnan and Dr. Hans Lee. The segment concludes with an overview of the pivotal studies that will frame the discussion, including CARTITUDE-4, MajesTEC-3, and MajesTEC-9, highlighting how emerging efficacy, durability, safety, and sequencing data are reshaping treatment strategies for patients with relapsed/refractory multiple myeloma.

Ongoing studies are evaluating teclistamab-based regimens in the frontline setting as well as smoldering multiple myeloma, according to Surbhi Sidana, MD.

A potential FDA approval of teclistamab/daratumumab would offer a “highly effective” option in multiple myeloma.

Panelists discuss the growing importance of early integration and collaboration between community oncologists and specialized centers in the evolving chimeric antigen receptor (CAR) T-cell therapy landscape for multiple myeloma, emphasizing timely referrals, coordinated care, and strategic sequencing with other immunotherapies to optimize patient outcomes.

Panelists discuss the essential role of supportive care following chimeric antigen receptor (CAR) T-cell therapy in multiple myeloma, emphasizing infection prevention through prophylaxis, immunoglobulin replacement, and vaccination strategies, along with the importance of coordinated long-term management between CAR T centers and community oncologists to ensure sustained survivorship care.

Panelists discuss the need for consolidation and maintenance strategies following chimeric antigen receptor (CAR) T-cell therapy in patients with high-risk multiple myeloma, highlighting emerging real-world and clinical evidence supporting the use of agents like lenalidomide and bispecific antibodies to extend disease control and improve outcomes in those with historically shorter remissions.

Panelists discuss real-world evidence showing that chimeric antigen receptor (CAR) T-cell therapy is safe and effective in traditionally excluded populations with multiple myeloma, including those with comorbidities or central nervous system (CNS) involvement, emphasizing the role of multidisciplinary care, proactive toxicity management, and growing confidence in extending access to high-risk patients.

Panelists discuss emerging strategies to manage delayed neurotoxicity from chimeric antigen receptor (CAR) T-cell therapy in multiple myeloma, highlighting the predictive value of postinfusion lymphocyte expansion, the potential of early dexamethasone intervention, and the need for continued research and collaboration to refine toxicity prevention and ensure safer, broader use of CAR T in earlier treatment lines.

Panelists discuss the growing support for incorporating chimeric antigen receptor (CAR) T-cell therapy earlier in the multiple myeloma treatment pathway, emphasizing the importance of timely referral and personalized decision-making to maximize patient outcomes before disease progression or comorbidities limit eligibility.

Panelists discuss the critical role of sequencing B-cell maturation antigen (BCMA)-targeted therapies in multiple myeloma, emphasizing that administering chimeric antigen receptor (CAR) T-cell therapy before bispecific antibodies leads to better outcomes, while real-world evidence and emerging guidelines increasingly inform strategic decisions based on treatment timing, disease urgency, and patient-specific factors.

Panelists discuss the emerging real-world use of talquetamab as a bridging therapy before chimeric antigen receptor (CAR) T-cell treatment in patients with advanced multiple myeloma, highlighting its ability to rapidly reduce tumor burden and improve CAR T outcomes despite unique toxicities and emphasizing how clinician-driven innovation is shaping practice ahead of clinical trial data.

Panelists discuss the real-world comparison of ciltacabtagene autoleucel (cilta-cel) and idecabtagene vicleucel (ide-cel) chimeric antigen receptor (CAR) T-cell therapies for multiple myeloma, highlighting cilta-cel’s superior efficacy but higher toxicity and emphasizing the importance of tailoring treatment decisions to individual patient factors such as disease stage, health status, and personal preferences.

Panelists discuss the transformative impact of chimeric antigen receptor (CAR) T-cell therapy on treating relapsed/refractory multiple myeloma (R/R MM) in real-world settings, emphasizing improved patient outcomes, the expanding role of real-world evidence, and the nuanced decision-making required in selecting among newly approved, highly effective immunotherapies.

Panelists discuss how bispecific antibodies targeting B-cell maturation agent, GPRC5D, and FcRH5 are transforming relapsed/refractory multiple myeloma treatment (R/R MM) with promising efficacy, manageable safety profiles, and convenient off-the-shelf administration.

Panelists discuss how sequential B-cell maturation agent (BCMA)–targeting therapies can be effective despite potential resistance patterns, with experts evaluating factors like prior response duration, alternative targets like GPRC5D or FcRH5, and patient-specific characteristics when deciding treatment sequencing after CAR T progression.

Panelists discuss how teclistamab administration and outcomes vary between academic and community settings, highlighting the need for standardized monitoring protocols, staff education, and communication frameworks to ensure consistent patient care and safety across different practice environments.

Panelists discuss how long-term follow-up data from MajesTEC-1 demonstrates teclistamab’s sustained efficacy and safety profile while identifying optimal candidates based on factors like prior therapy exposure, disease characteristics, and fitness level.

Panelists discuss how talquetamab demonstrates superior efficacy compared with physician-chosen treatments for patients with heavily pretreated multiple myeloma, with improved progression-free survival and response rates.

Panelists discuss how emerging therapies like bispecific antibodies, chimeric antigen receptor (CAR) T cells, and novel drug combinations are reshaping treatment options for patients with relapsed/refractory multiple myeloma (R/R MM) who have exhausted standard approaches.

Panelists discuss effective strategies for promoting the adoption of bispecific antibodies in relapsed/refractory multiple myeloma (R/R MM) treatment, emphasizing the importance of educational initiatives, improving care transitions between academic and community settings, addressing misconceptions, and sharing key takeaways and clinical pearls for community oncologists.

Panelists discuss strategies for sequencing bispecific antibodies with B-cell maturation antigen (BCMA)–targeted therapies, considering factors such as prior CAR T-cell treatment, the impact of relapse timing on treatment decisions, and approaches for managing high-risk cytogenetics and extramedullary disease in relapsed/refractory multiple myeloma (R/R MM).

Panelists discuss the rationale behind combination strategies with bispecifics in relapsed/refractory multiple myeloma (R/R MM), highlighting key studies such as RedirecTT-1 for teclistamab and talquetamab, TRIMM-2 for talquetamab and daratumumab, and MagnetisMM-32 for elranatamab, along with considerations for step-up dosing and outpatient administration protocols.

Panelists discuss recent updates in the management of relapsed/refractory multiple myeloma, focusing on key studies such as MonumenTAL-2 for talquetamab, long-term follow-up data from the phase 1/2 MajesTEC-1 for teclistamab, and findings from MagnetisMM-3 regarding elranatamab.

Panelists discuss how the current treatment landscape for relapsed/refractory multiple myeloma (R/R MM) includes standard options like such as IMiDs, PIs, and mAbs, while highlighting the emergence of novel therapies such as CAR T- cells and bispecific antibodies, which address unmet needs and offer potential advantages in treatment efficacy and patient outcomes.

Surbhi Sidana, MD, spoke about multiple myeloma developments with the potential to impact clinical practice, particularly early line use of bispecific antibodies.

Surbhi Sidana, MD, discussed LINKER-MM1 trial efficacy findings, in which linvoseltamab was evaluated in patients with relapsed/refractory multiple myeloma.

Surbhi Sidana, MD, discussed outpatient supportive care for patients following immunotherapy treatment for hematologic cancers.

The panel concludes the discussion by offering future perspectives on the evolving treatment landscape in multiple myeloma, highlighting exciting developments and ongoing research.

Continuing discussion centered on a patient case, the panel discusses bispecific antibody combinations and the role of BCMA-targeting CAR T-cell therapies in relapsed/refractory multiple myeloma.