Can patients be given treatment free intervals?

The short answer right now is no, because as I said, myeloma patients have some form of treatment all throughout the life, but that is likely, we hope is going to change. So there are two things that we are doing right now, and they're emerging treatments that also is providing some hope that we can provide treatment for interval. One is stopping treatment based on certain response, specifically looking at the MRD and achieving MRD at a certain point of time, or maintaining that MRD at a certain point of time, and that patients potentially can be offered treatment for interval. So that trials are already ongoing. So that is one kind of a way that we probably would offer the treatment for interval. And number two is there are certain treatments, for example, like CAR-T, which gives one and done afters, and often that patients are just observed without any treatment. So that is a unique example where patients are given the treatment for interval. We can see all this data that is emerging in the CAR-T, and all these patients are observed without any treatment, and they have been doing very well without that. And also in my clinical experience, I can tell they have a very good quality of life. And based on the MRD thing, we completed a biggest study called Master's Study, where we had that approach of stopping the treatment after two consecutive MRD negative results. And then there we saw about 60% of the patients, more than 60% of the patients were able to enter into this treatment free interval, where you can just observe those patients without So I think those studies will come and then hopefully will mature and then we can, most likely, I'm very hopeful that certain segments of patients or maybe large segments of patients can be offered treatment for interval using that approach. And also moving this CAR-T upfront in the early lines, hopefully we can offer treatment for interval in those patients. So treatment holidays are an important concept to always discuss with your care team. For the most part, the current gestalt of myeloma is to treat until progression or intolerability. But there's an old saying, never let perfection be the enemy of the good. So sometimes people do need treatment holidays. This is optimally done with a therapy that maybe has a longer half-life. So a drug like daratumumab has a long half-life. So skipping a dose or two, there's still drug in your system. Best to do this in periods where the disease is under control and not in a full relapse. So we can always work with patients and their caregivers to work on treatment holidays and try to optimize those times, especially if you're going to go away on a trip or some big family event. Right. Again, I think that's a great question. And I think it's a very important question. Patients are, it's great because patients are living a very long time, but also we have to think as a field much, much more about quality of life and things like being able to go on the vacation and just being free from the side effects of the medications. I feel like the biggest side effect for many of my patients, not even the actual organic side effects, but the mental side effects of having to schlep all the way to the infusion clinic. Here, I practiced in the Northeast where it was less of a problem because things are closer together. But here in Florida, I can see I have patients that travel three hours for each infusion potentially. And I think that can be very taxing. And so I do believe in general that it is okay to get treatment holidays. I think it depends on the patient and when in the patient. I think sometimes it's very difficult because the patient needs that holiday because, for example, the myeloma may be getting slightly out of control and whatnot. And that's when we really need to sort of sit down and kind of focus on the myeloma. But in general, I do like to give you examples. I think one of the best times, and I tell my patients, is during that initial, after you receive the combination therapy and maybe a transplant for myeloma, that maintenance time is a great time. I tell patients, you should take time off. You can always take the pills. You can take a break if they wanted some other procedure done or for whatever reason. I feel like it's okay to take a month off, for example, if they really need to. And I do also allow for vacations or drug holidays because I truly feel like we have to treat not only the myeloma, but as old-fashioned as this sounds, we do need to treat the patient as a whole. And sometimes you really need to treat other things in the tumor and maybe the patient really does need some time off. So I try to work personally as closely as I can.