Frontline Therapy in Multiple Myeloma | Claudio Cerchione, MD | IMS 2024

There is an ongoing revolution in therapeutic panorama multiple normal, starting from frontline where as much as the combinations are effective, the objective, the endpoint, it becomes more ambitious and I think that we have to underline that the new monoclonal antibody-based combinations, our endpoint, it becomes not anymore a PFS for esophysicist revival but MRD negativity. We should offer to our patients the best as possible, the fastest response which correlates with the best outcomes. Currently we continue to divide the patient in transplant eligible and not eligible, particularly starting from the first one in which Dara-Tumumab is the backbone together with the BtD which is going to be replaced by VRD and then auto transplant, single or double continuing maintenance after the consolidation strategy. In transplant in eligible patients there are many novelties ongoing. Dara-RD or Dara-VMP in this moment are standards of care but according to in-broad study I think that these atooks of VRD is potentially becoming a new standard of care and also in the elderly population we should aim to obtain the deepest responses possible and MRD negativity, particularly in frontline settings, has to become an affordable endpoint what we really want to offer to the patient the best long-term survival and quality of life. Starting from the relapse I have to say that we have currently a lot of antibody-based combinations like ESA-KD, ESA-PONDX, Dara-PD that we use in patients that have obtained a wonderful response in frontline treatment, monoclonal antibody-based only in the ones that are naive for antidepressants. But we have also other class of actions such as XPO-1 inhibitors, selenexors and XRVD is a strategy that we are going to use in second line in patients in which we want to switch to another strategy, to another mechanism of action. However, we have these possibilities also in transplanted eligible population and we have to care also about the other opportunities that are arriving. The new generation immunotherapies started from earlier lines we are going to use also in our clinical practice, be specific antibodies, decrease AMEDERL1-ANATOMAB are approved and reimbursed and I think that the data are concrete, are fantastic in terms of efficacy, of tolerabilities becoming better thanks to the improvement of the management and I think that also CAR-T are becoming not anymore a dream but something that we can concretely do in our daily life activities. In terms of clinical trials, many new approaches are coming. I particularly care about cell modes, particularly mezigdomide, successor programs, successor 1, successor 2 are showing the results together with bortezomib and carfizome and I think that mezigdomide is a potential game changer in the next future. Let's not forget the reworking of belata amafodatin, DREAM7 and DREAM8 have shown the superiority to the control arm that are human based in combination with bortezomib and pomalidomide and I think that we will go to reposition in monocular antibody refractory population belata amafodatin with the new dosage and new combination and wonderful effectiveness and I'm really proud that with my institution we were inside this program and inside the wonderful paper that has been published about DREAM7. What about other patients? Let's not forget the need to switch in some patients to immunotherapy free strategy and I think that meflufen is in this sense are opportunities that we are going to position in our daily life. According to all these approaches and opportunities I have to say day by day, month by month we are changing our approach, we are changing our endpoints that are becoming more and more ambitious but according to these novelties I have to say that the cure for our patients maybe is not anymore only a dream and it's becoming something concrete and this is the best wish that I give to all our patients, their caregivers, meloma researchers, everyone that every day fight against multiple meloma.