eCase - Therapeutic Strategies in Myeloma

Introduction

In this module, Shaji K. Kumar, MD discusses key data across the treatment spectrum of multiple myeloma (MM), including emerging targets and therapies.

Please note that the slide thumbnails in this activity link to a PowerPoint slideset supplementing the discussion by the faculty. This slideset may be downloaded by clicking on any of the thumbnails within the activity.

Clinical Care Options plans to measure the educational impact of this activity. A few questions will be asked twice: once at the beginning of the activity, and then once again after the discussion that informs the best choice. Your responses will be aggregated for analysis, and your specific responses will not be shared.

Before continuing with this educational activity, please take a moment to answer the following questions.

If you are a practicing healthcare professional (HCP), how many patients with MM do you provide care for in a typical month?

A.
1-4
B.
5-10
C.
11-15
D.
16-20
E.
>20

A 51-year-old asymptomatic woman was found to have an IgAk paraprotein during a routine exam. On further examination, her M-protein component was 1.2 g/dL but her free light chain ratio (FLC), renal function, hemoglobin, and calcium levels were normal.
A diagnosis of monoclonal gammopathy of undetermined significance (MGUS) was established and follow-up every 6 months was recommended.

She remained stable for 3 years, at which time she consulted with a myeloma expert and her M-protein component was found to be 2.3 g/dL, with FLC ratio of 35 and Bence-Jones proteinuria of 500 mg/24h. Bone marrow biopsy revealed 32% plasma cells (97% clonal), with t(4;14) cytogenetics. A CT scan was negative, but MRI showed 1 focal lesion in her right femur.
A diagnosis of smoldering MM (SMM) was established.

Would this patient with SMM be a candidate for initiation of treatment at this time?

A.
No, no role for treatment until progression to active MM
B.
No, due to low-risk features
C.
Yes, due to intermediate-risk features
D.
Yes, due to high-risk features
E.
Uncertain

A 62-year-old male with past medical history of GERD is newly diagnosed with MM. He also has high-risk cytogenetics with t(4;14) and del(17p) and is determined to be fit for autologous stem cell transplant (ASCT). Based on available data, which of the following regimens would be preferred for this patient?

A.
Bortezomib/lenalidomide/dexamethasone (VRd) induction, followed by lenalidomide maintenance until progression
B.
VRd induction, followed by ASCT and observation
C.
Carfilzomib/lenalidomide/dexamethasone (KRd) induction, followed by ASCT, consolidation and lenalidomide maintenance therapy
D.
KRd induction, followed by ASCT, consolidation and lenalidomide + carfilzomib maintenance therapy
E.
Carfilzomib/cyclophosphamide/dexamethasone (KCd) induction, followed by ASCT, consolidation and lenalidomide + carfilzomib maintenance therapy
F.
Uncertain

A 69-year-old female presents with fatigue and back pain and her primary medical history includes hypertension. She had Eastern Cooperative Oncology Group (ECOG) performance status of 1 and laboratory tests showed : hemoglobin of 9 g/dL, calcium of 8.7 mg/dL, creatinine of 1.6 mg/dL, beta-2 microglobulin at 5 mg/dL, albumin of 3.6 g/dL, LDH within normal limits, M-protein at 5.2 g/dL, IgG-kappa, and kappa FLC of 92 mg/L, and lambda FLC of 9.2 mg/L.

Plain films showed multiple lytic lesions and bone marrow biopsy revealed 50% plasma cells with no high-risk cytogenetic abnormalities. For first-line treatment, she received VRd followed by ASCT and lenalidomide maintenance (stopped after 18 mo due to AEs), but experienced progressive disease after 34 months. Subsequent lines of therapy included daratumumab/lenalidomide/dexamethasone (Dara-Rd), pomalidomide/cyclophosphamide/dexamethasone, and carfilzomib/dexamethasone (Kd).
Currently exam shows a progressive vertebral lesion and the patient desires aggressive treatment with the highest likelihood of response.

In your current clinical practice, what would you recommend for this patient after multiple relapses?

A.
CD38 monoclonal antibody (mAb)-based combination
B.
BCMA-targeted CAR T-cell therapy
C.
Selinexor-based therapy
D.
Teclistamab
E.
Venetoclax-based therapy (off label)

Which of the following investigational bispecific antibodies targeting BCMA could be an option on clinical trial for patients who are refractory to an IMiD, PI, and anti-CD38 mAb?

A.
ABBV-383
B.
Cevostamab
C.
Linvoseltamab
D.
Talquetamab
E.
ABBV-383 and linvoseltamab
F.
Cevostamab and talquetamab

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Therapeutic Strategies in Multiple Myeloma: Overview of Current and Emerging Treatment Options

Shaji K. Kumar, MD

Activity

Introduction

If you are a practicing healthcare professional (HCP), how many patients with MM do you provide care for in a typical month?

Would this patient with SMM be a candidate for initiation of treatment at this time?

In your current clinical practice, what would you recommend for this patient after multiple relapses?

Which of the following investigational bispecific antibodies targeting BCMA could be an option on clinical trial for patients who are refractory to an IMiD, PI, and anti-CD38 mAb?