Dr Siegel on the Need for Durable Remissions in Patients With Multiple Myeloma

David Samuel Dicapua Siegel, MD, chief, Division of Multiple Myeloma, John Theurer Cancer Center, Hackensack University Medical Center, discusses unmet needs and current challenges within multiple myeloma treatment, including efforts to promote more durable remissions in specific patient subsets as well as to determine whether the use of cellular therapies earlier in the treatment course is the optimal approach.

Despite significant advancements in the treatment of multiple myeloma, the goal of curing patients remains elusive, Siegel begins, adding that this remains one the most critical unmet need in the field. There have been instances where patients achieve decade-long remissions following stem cell transplants, and occasionally, extended remissions are seen after other interventions, he details. In these cases, it seems a subset of patients are nearing the point of cure, Siegel says. However, achieving this for the majority is still a challenge.

For the majority of patients with myeloma, remissions are not this durable, Siegel continues. Therefore, the focus needs to be on developing strategies to extend these remissions and include more patients in the group that experiences long-term disease control, he says. The ultimate objective should be to find treatment approaches that allow patients to enjoy long periods without the need for ongoing therapy. This not only improves their quality of life but also reduces the burden of continuous treatment.

Innovative approaches, such as immunotherapy, CAR T-cell therapy, and next-generation targeted therapies, are already showing potential in extending remissions. Currently, there are substantial data on the role of cellular therapeutics earlier in the course of care for multiple myeloma, and the option to use CAR T-cell therapy for patients at their first or second relapse is becoming increasingly viable, Siegel states. The challenge now is to determine if this is the most appropriate approach, he explains. As clinical experience with CAR T-cell therapy grows, it will be crucial to collect and analyze real-world data to identify which patients benefit the most and which patients might be at higher risk for adverse outcomes, given the associated mortality rate, Siegel explains. By understanding these nuances, clinicians can make more informed decisions about when and how to deploy CAR T-cell therapy, ensuring that it is used in the most effective and safe manner possible, he concludes.

As the myeloma community continues to explore the integration of CAR T-cell therapy into earlier stages of treatment, the goal remains the same: to extend remissions, improve quality of life, and move closer to the possibility of curing multiple myeloma.