Extending patients' time in Myeloma

The first morning at ASCO is filled with time-related questions. Is 9:30am too early to have an $18.50 tomato-and-lettuce lunch sandwich? How many time-zones do you cross walking all the way to room E451? And if I get in the Starbucks queue now, will I get a coffee in time for the Plenary session tomorrow afternoon?

Time is always front and centre at ASCO. Oncology medical care is about extending patients’ time; it is the over-riding metric by which new drug utility is measured. And the focus is particularly poignant when considering patients who continue to progress after multiple lines of drug therapy. Saturday’s Poster Discussion Session in Hematologic Malignancies delivered a captivating discussion from panel members regarding the use of novel drug classes in this patient type within Myeloma. Data was presented showing positive clinical responses to BCMA-targeting bi-specific agents in heavily pre-treated patients (many of whom were penta-refractory) and offered a view on the balance of the developmental bi-specific drug class versus the recently approved ADCs and CAR-Ts targeting the same marker. A balance which weighs up clinical efficacy; the depth and durability of response and overall PFS, with the manageability of side effects and logistical access to the treatment.

With the three drug classes showing significant benefits in such an at-need patient group, a question from the floor soon turned the discussion toward sequencing, with a focus on how to achieve the best possible outcomes for the patient sitting in front of the clinician. The presented data had shown continued response when switching drug class within the BCMA-target marker, with bi-specifics showing efficacy in patients with prior BCMA-experience (CAR-T or ADC). The question was raised as to whether the inverse may also be true; could the bi-specifics be used as a bridge to CAR-T, for patients in the waiting room for autologous T-cell therapy?

After heated discussion, it became clear that we do not yet know the optimal approach to activating the immune system to drive tumour regression in Myeloma, and therefore how to gain the most time for these patients. What was even more clear was the passion from the panel of clinicians to find the answer.