My name is Suzanne Nensch. I'm the director of the multiple myeloma and amyloidosis program at Columbia University. And I'm here at the IMS 2024 in Brazil. It's very hot. Nevertheless, we work very hard for our multiple myeloma patients. And this morning I presented at a symposium where we discussed especially the best treatment for elderly patients. How do we really sequence our treatment? So we heard data about Bilanthamab that in combination with Velcade and Vestara Toolmap showed very excellent data. We have right now CAR T cell approved for the first relapse. And we also have bispecifics, which are currently approved for the third and fourth line treatment in multiple myeloma. But of course, will be approved I think in the future for earlier lines of treatment. So the big question we have is what is the best approach for our patients? Is it BCMA CAR T cells? Is it BCMA bispecific cells? Or is it the BCMA drug conjugates that means Bilanthamab? So my approach is really that it should be patient specific. What I really like to suggest my younger patients who are not frail is CAR T cell treatment. I think we have the best data with CAR T cells in terms of long term, progression free survival. We are concerned about some side effects. We know that the patients can develop CRS, cytokine release syndrome. But what I think is even a bigger problem, especially for older patients, is the neurotoxicity. Patients who are alien might have some underlying neurotoxicity already or neurological problems. Parkinson's, for instance, I don't think that those patients are the right patient group to get CAR T cells because we know that we have 20% of possibility of neurotoxicity. Parkinson's like syndrome for instance. Bispecific, the bispecific T cell engagers. I think a treatment which we give very limited is an option, especially for older patients. But we have to make sure that the patients do not have major underlying infectious problems. Patients with recurrent sinusitis or with several pneumonias over the last years are not good candidates for bispecific antibodies. Why is this? We know that the infection risk for severe infection is very high. So I think for those patients who are older, have maybe neurological underlying problems and have increased infection rate, balantamab as a drug-conjugated BCMA antibody is an additional good option for those patients. The nice thing is we have seen that we can stretch the intervals in those patients. So the maintenance is even every 12 weeks, which is very convenient for those patients. I hope we will have more data and especially safety data coming up in the next day presented here at INS.
HealthTree • October 8, 2024