Ola Landgren, MD, PhD, highlights how future research efforts in multiple myeloma are likely to focus on chemotherapy-free regimens and minimal residual disease detection.
In an interview with CancerNetwork®, C. Ola Landgren, MD, PhD, a professor and leader of Experimental Therapeutics and Myeloma Service at the Sylvester Comprehensive Cancer Center, University of Miami Health System, details his thoughts on upcoming research within the multiple myeloma space. In particular, he foresees efforts focused on chemotherapy-free regimens and the detection of minimal residual disease.
Moreover, he described how findings from the phase 3 DETERMINATION study (NCT01208662)—assessing the use of lenalidomide (Revlimid), bortezomib (Velcade), and dexamethasone (RVd) plus autologous stem cell transplant vs RVd alone, both with continuous lenalidomide maintenance, in patients with newly diagnosed multiple myeloma—might impact clinical research moving forward. Findings from the trial indicated that progression-free survival was longer in the transplant group vs RVd alone, although there was not a significant difference in overall survival.
As an extension of the DETERMINATION study, and also as an extension of all the other myeloma studies that were presented [at the 2022 American Society of Clinical Oncology Annual Meeting], what we are seeing is how the treatment [landscape] is changing for patients with myeloma. When I started my career, we gave hefty chemotherapeutics intravenously in the hospital and every patient [underwent transplantation]. Now we’re talking about delaying or never transplanting some patients. We are [also] talking about [novel] immunotherapies. [Data from the] meeting articulated very exciting, updated information on the new bispecific antibodies and CAR T-cell therapies. What’s going to happen is that we’re going to have chemotherapy-free treatments for myeloma coming into earlier lines of therapy in the coming years. Perhaps the newly diagnosed patients will also be treated with chemotherapy-free regimens in the near future.
It is going to be very exciting. In parallel with all the drug development, we will also see more and more data on minimal residual disease detection. I [have] worked [on this] for over 15 years, [and] there are many others in the field who have spent a lot of time working on that. We will see patients achieving deep responses—MRD-negative patients having sustained MRD negativity. I also predict that with the newer therapies, in particular if they are started earlier, [perhaps] patients [could] have sustained MRD negativity as a bridge towards either stopping therapy permanently or being off therapy for extended periods of time and being monitored. That’s also amazing.
Richardson PG, Jacobus SJ, Weller EA, et al. DETERMINATION Investigators. Triplet therapy, transplantation, and maintenance until progression in myeloma. N Engl J Med. Published online June 5, 2022. doi:10.1056/NEJMoa2204925