Duration of Therapy and De-escalation: Navigating the Unknowns

Joseph explains that all current data come from continuous-therapy trials in which treatment proceeds until progression or intolerance. However, she notes that clinical research is now exploring fixed-duration strategies, including randomized trials evaluating discontinuation after 1 year. In her own practice, she personalizes dosing by de-escalating frequency—transitioning patients from monthly to every-8-week dosing—especially when cytopenias are problematic. She emphasizes that bispecifics maintain prolonged pharmacodynamic activity, making less frequent dosing feasible without losing efficacy.

Nooka provides a research-driven perspective, highlighting that without controlled data, discontinuation decisions remain speculative. Yet he acknowledges that sustained MRD negativity raises the possibility of functional cure, a scenario in which stopping therapy may become reasonable.

Krishnamachary brings the community viewpoint, noting parallels with checkpoint inhibitors in solid tumors, where patients often prefer treatment breaks once durable remission is achieved. Patient preference, quality of life, and shared decision-making—all central in myeloma—must inform duration strategies.

The segment ends with recognition that infection risk remains the major barrier to indefinite therapy, prompting clinicians to balance depth of remission with safety. As evidence evolves, de-escalation and fixed-duration approaches are likely to shape the next era of bispecific treatment strategy.