Vincent Rajkumar, Professor of Medicine at the Mayo Clinic in Rochester and Editor‑in‑Chief at Blood Cancer Journal, shared a post on X:
“I am scared of using CART or bispecifics in myeloma with large volume disease: CRS, neurotoxicity, HLH, risk of death, and all kinds of complications are much higher.
I’d rather control myeloma and get it to low volume before using these immunotherapy treatments.
This is why we need more new classes of myeloma drugs. CARTs and bispecifics are great treatments and can prolong life for a long time if we use them correctly. But if say DaraVRd and KPd don’t work, you are quickly out of good options to control myeloma, and then we are forced to sometimes take the risk with bispecifics and CART despite of large volume disease.
So while we have a lot of treatment options in myeloma, that’s context-dependent. Many of the options are in similar drug classes and don’t really work well if DaraVRd and KPd don’t. For biologically aggressive refractory myeloma, we have a ways to go.
In this regard, I feel drugs like Belantamab, if approved, can offer one way of reducing tumor burden to enable the use of CART and bispecifics. Of course, Belantamab alone is not going to help either. We need a lot more new drugs with new mechanisms of action, if not for anything else but to debulk so we can safely use bispecifics, trispecifics, and CART.”
Taha Al-Juhaishi, Associate Program Director of Hematology and Oncology Fellowship at the University of Oklahoma Health Sciences Center, shared this post, adding:
“Very important message on how to optimize your use of CAR-T cell therapy. I would argue the same message applies in lymphoma, it’s context-dependent too.
Debulk the disease first, then consolidate with cells for a safer and likely more efficacious approach. Timing is the art of oncology.”
More posts featuring Vincent Rajkumar on OncoDaily.