Thierry Facon, MD, spoke about treatment combinations that have seen success in patients with multiple myeloma, as well as where future research should be focused.
During the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting, CancerNetwork® spoke with Thierry Facon, MD, Haematology Division head and assistant professor of hematology at Lille University Hospital in France, about how previously presented data are informing his view of the future treatment of multiple myeloma. He reviews data surrounding daratumumab (Darzalex) in combination with bortezomib (Velcade) and dexamethasone with either thalidomide (VTd) or lenalidomide (Revlimid; VRd), combinations that he sees as the current standard-of-care in the frontline, and about how bispecific antibodies will play a crucial role in future trials.
We have several reports on BCMA [B-cell maturation antigen] bispecific antibodies and we have several quality studies in relapsed myeloma [being presented at 2022 ASCO], so this is definitely very exciting. When you look at traditional studies like the CASSIOPIEA study [NCT02541383] with daratumumab plus VTd, the GRIFFIN study [NCT02874742] with daratumumab/VRd, and others, these studies of anti-CD38, proteasome inhibitors [PIs], and immunomodulatory drugs [are the standard].
From my point of view, at the time of 2022 ASH [American Society of Hematology Annual Meeting] or 2023 ASCO, this will be a debate that will be somewhat closed. We will just jump into a new world with the standard of care being anti-CD38 with VRd or with KRd [carfilzomib (Kyprolis), lenalidomide, and dexamethasone]. The combination of PIs plus anti-CD38 will be the landscape and the first-line [setting] will be defined for a few years. The next step is between 2023 and 2028. We will have to figure out new regimens.
There is much interest and a lot of enthusiasm for bispecific antibodies. These drugs are not well-known in terms of duration of therapy, treatment schedule, and dosing. If you want to [administer] a bispecific antibody, should it be given until disease progression or [during a] fixed version of therapy? What if you want to implement a bispecific antibody in [a patient who is] elderly or frail? What do we know exactly about durability in the long term? These are very important questions. What we know with DRd [daratumumab, lenalidomide, and dexamethasone] is that you can keep going for a very long time. It’s clear that we will have to figure out new regimens. Some of these regimens will not be continuous regimens, some drugs could be continuous. It seems to be simple, but at the end of the day, it’s still a lot of work to do.