Future Strategies for Managing 2nd Line+ Myeloma: What’s Next? | Leo Rasche, MD | IMS 2024

Hello everyone, my name is Leo Rascher. I'm a physician from the University Hospital of Würzburg in Bavaria, Germany. And I had the chance to have a good discussion here at the IMS around second line plus treatment. So how can we treat it? What are the options at relapse? And the bottom line of all this, there is a lot of options and a lot of hope, even in relapse. So in other words, it's the second chance for a long lasting and good remission. So one key aspect or one key advantage of today is the introduction of the novel immunotherapies. And there is very good and solid data on CAR T cells, BCMA CAR T cells for second line plus patients. So it is, lately we talked about CAR T cells in last line or in fourth line plus, but now we have the data for second line plus. And as far as we know, many patients will go in a long lasting remissions for two or even three years, even in the relapse settings. Then a key element for monitoring the disease is imaging. It's also something we have discussed intensively. So myeloma is a patchy disease. And especially at relapse, sometimes imaging is the sole technology to really monitor the disease. So this is very important to have it on board when it comes to monitoring of the disease. Then there is the question of the sequence of immunotherapies. Should we do CAR T first or bispecifics? Should we change targets? All this is, I would say not 100% clear. But as far as we know, we should start with CAR T and then salvage with bispecifics. And here again, good news, there are several bispecific antibodies targeting different targets. So even after failure of one bispecific, there is another one we could use and to get the disease controlled and to achieve a good remission. So overall, I would think in myeloma, it's still a terrible disease, but we are somewhat in a luxury position of having so many options, so many good options to achieve what the patient wants. And that is a long lasting remission with a long lasting treatment free interval and good quality of life.