ASCO/EHA Myeloma Updates 2024 | Claudio Cerchione, MD | EHA 2024

Hello everybody, I am Claudio Cercione. I work in Istituto Romagnolo per Ossurio dei Tumori di Namadori, located in Meldola, northern part of Italy. And I'm really happy and honoured to do this interview for Health Tree, which I particularly consider as a fair for patients worldwide. And I think that it's really important to focus on what we have learned from EHA and ASCO 2024. The revolution in multiple malomers continuing. We have many novel agents, many new combinations and it is an incredible moment also for diagnostic tools that are becoming really important for optimising treatment. Particularly appreciated the new data about frontline treatment, we are going to have many new options. Monoclonal antibodies, daratumab and disatuximab are the backbones. The partners are changing, VRD, KRD, many new options to be added to the monoclonal antibodies. I think that data are exciting. The new end point is going to become the MRD negativity. Sustaining the MRD negativity is something that we should aim to reach for every patient in which we have an intent to treat. And I think that this data, also considering the ones that are going to improve the maintenance, thanks to the addition of CAR-T to the patients that have performed autologous sensor transplantation, are something really important that we take home from this important conference. What about relapsed refractory setting? First, there is a reworking of belantam-fodotin with two incredible trials, DREAM7 and REMATE. I am honoured to be one of the authors of a New England Journal publication of DREAM7 in which belantamab has been compared to daratumab. Belantamab-Bortezomib-Dexa versus Darabortezomib-Dexa. And I think that we can see if we anticipate the third line, belantam-fodotin, it is incredibly in synergism with the Bortezomib, data are exciting in terms of effectiveness but also tolerability. The ocular events are really rare, are really manageable and I think that we are potentially considering the progress of free survival. The very good patients reported outcomes were in front of a potential new standard of care, particularly in an anedomide refractory patients. The anedomide refractory patients that in this moment constitute a little bit an unmet clinical need and that's why I focused also about the preambo registry data in which I was first presenting author at THA 2024 in which we have found that overall response rate after refractoriness to anedomide is about 31%. We need more in these patients, one option could be DREAM7, belabortz-dex, other could be DREAM8, belantam-pomalidomide-dexamethasone but also selinex or Bortezomib-dexamethasone is something that we can use when the patient achieved the refractoriness to an anedomide. What about the following lines? B-specific antibodies are consolidating their data in terms of monotherapy in which we see solid data in terms of response, also the tolerability is improving thanks to the teaching that we are doing each other about how to manage adverse events, the prophylaxis of patients that is something really important and I think that molecules like teclistamab, elranatamab but also other specific antibodies that are on the horizon are something that is game changer for our relapsed refractory patients. CAR-T are something that we have tested not so much in our daily practice but from clinical trials we are going to see that the data are more and more solid, there are other options, other potential sequencing and I think that also data or real world analysis are confirming that we need as soon as possible also for our daily patients and I think that we are going more and more to focus about sequencing. Sequencing is something that should be in the mind of meloma researchers because we should find a way to define the right patient for the right drug or combination and that's why institution like Mines are performing a new generation of profiling of the patients, particularly adding new imaging methods such as VULBODY MRI to PET-CT, adding molecular analysis of our patients. We presented in our communication at TASCO 2024 the addition of new diagnostic methods VULBODY plus PET-CT for all the patients, in some way 26% of our patients could benefit of a change of their management thanks to the combination methods. We are in some way adding molecular data to this analysis because we are performing the SCI-92, a new molecular assay to all our patients. The combination of multi-omic project, molecular evaluation, imaging evaluation, metabolomic and the clinic evaluation will be combined in which will be maybe a potential new prognostic score. I think that the therapy changing has revolutioned in last years but we have also to a little bit stop, freeze our running in new developments and to think also a little bit about the diagnostic. Improved diagnostic means optimization of what we have today, means optimization of the discovery of potential relapse, means optimization of patient journey. Another important topic is the prevention of meloma. In my institution we are particularly caring about the high risk smoldering meloma detection, understanding which are the patients that should be treated. The idea of prevent patient to develop multiple meloma to treat before they became symptomatic is something that should be really an hot topic, a really unmet medical need. And that's why we are in some way doing an awareness campaign in which we want to discriminate between M-Gas smoldering meloma and particularly detecting high risk smoldering meloma, the ones that should be put in clinical trials. There are ongoing clinical trials that are showing great results with the monoclonal antibodies but also specific antibodies. Currently we are enrolling for EMN 34 and an Atom-AMB trial for these patients. I think that we should also in some way be ambitious for patients that are not healed at this moment. The end point should be MRD negativity. We want to cure them, not only to in some way point out the progress of resurvival improvement. We want to eradicate the disease in these patients. So I think that we can make at home from this couple of conferences with many ideas, many results. Meloma is one of the main characters in hematological malignancies world and this is thanks to the researchers that are having exciting results in these years. And I think that the cure of multiple meloma is not so far and this is the best wish that I give to our patients, to our caregivers and to all meloma researchers that every day fight against this strong disease.