Future Directions for Addressing Unmet Needs in the Multiple Myeloma Space


Paul G. Richardson, MD, discusses the unmet medical needs that still exist in the multiple myeloma space.

Paul G. Richardson, MD, clinical program leader and director for Clinical Research, Jerome Lipper Multiple Myeloma Center, institute physician at Dana-Farber Cancer Institute, and RJ Corman professor of Medicine at Harvard Medical School, discusses the unmet medical needs that still exist in the multiple myeloma space.

According to Richardson, the prognosis of myeloma has improved from a median survival of 2-3 years to 7-15 in the last 22 years. Although there have been 14 approvals in this space within the last 20 years, including for belantamab mafodotin (Blenrep), melphalan flufenamide (Melflufen), chimeric antigen receptor (CAR) T-cell agents like idecabtagene vicleucel (ide-cel; Abecma), and ciltacabtagene autoleucel (cilta-cel; Carvykti), the unmet needs in myeloma remain complex.

Richardson notes that while updates in the field have helped patients in many ways, myeloma remains incurable. Further research regarding rates of remissions, ways to increase survival, advancements in therapies, and more is needed within the space to improve patient outcomes.


0:08 | There's a lot of unmet medical need. I think 1 of the most interesting areas that we're looking at is how to further refine therapies strategically. One aspect of my presentation is looking at the evolving position of transplant, recognizing that high dose melflufen has been a mainstay of therapy, and targeting stemness in myeloma has been absolutely critical. Melflufen provides an example in a very targeted way of trying to exploit that platform. The challenge with transplant is that for a while, we realized that whilst is very effective at improving response [and] improving progression-free survival, it doesn't appear to have a meaningful impact on overall survival, which is really interesting in the era of novel therapies, so we're trying to make sense of that.

0:52 | The reason I'm focusing on that is because we're learning that what you do early in the patient's course of treatment can affect what happens later. We need to think strategically about myeloma and obviously, the goal is functional cure, recognizing that myeloma remains, unfortunately, still incurable in a practical sense. But functional cure and driving towards long term remissions that enhance quality of life as well as quantity of life, our overriding goal. I think when you put that together in composite, the biggest unmet medical need is, how do we further deal with resistance and relapse? Not only have we talked about BCMA, and existing standard agents, but we have new targets that we're going after. These are particularly important in the relapse setting.

1:40 | The unmet medical needs in myeloma remain complex, but I think what's an important takeaway is that in the last 22 years, the prognosis of myeloma has improved from a median survival of around 2-3 years to 7-10, to 15. That's dramatic in the same period of time. Right now, we're sitting on up to 16 approvals. We've had 2 approvals that have been pulled back, so we're at 14, but we've had 14 approvals in the last 20 years. This is really remarkable progress, and we're hoping that that progress will continue.

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