The Evolving Goal in Multiple myeloma Treatment: Striving for Curative MRD Negativity
The landscape of multiple myeloma treatment is shifting. While historically focused on disease control, overall response rates, and progression-free survival, the new ambition is far more profound: achieving the deepest possible response, ultimately leading to minimal residual disease (MRD) negativity and, potentially, a cure.sustained MRD negativity is increasingly viewed as the key to long-term remission in this challenging cancer.
Current treatment strategies are already demonstrating remarkable disease control,especially with the advent of quadruplet therapies. The combination of isatuximab, a next-generation anti-CD38 antibody, with the established VRD regimen (bortezomib, lenalidomide, and dexamethasone) is rapidly becoming the new standard of care. The INNROAD clinical trial has showcased compelling data demonstrating the depth of response achievable with this combination, alongside surprisingly good tolerability.
Despite logistical hurdles for patients, this regimen consistently reports high quality of life and patient satisfaction. This positive experience is driving a move towards quadruplet therapy as the preferred frontline approach, recognizing that the most impactful treatment may be delivered at the time of initial diagnosis to maximize long-term control. The focus is on continually refining and improving treatment to secure the best possible outcomes for patients.
Personalizing Treatment in the Modern Era
The treatment of multiple myeloma is becoming increasingly individualized. Beyond the traditional categorization of patients as transplant-eligible or ineligible, a comprehensive assessment of the patient’s overall condition is crucial. This includes evaluating frailty scores and pre-existing comorbidities.
The shift from chemotherapy to immunotherapy was a revolutionary step, and now immunotherapy itself is becoming more personalized. Monoclonal antibodies generally exhibit excellent tolerability, making them suitable even for elderly patients. The decision to utilize a quadruplet regimen is directly linked to the patient’s general health status. Offering the most potent treatment option, even if clinical trials previously set an upper age limit of 80, can yield the best results when a patient is or else fit.
Managing Safety and Tolerability with Anti-CD38 Quadruplets
A key advantage of adding isatuximab to a regimen is that it doesn’t substantially worsen tolerability. Clinical trial data indicates that the side effect profile remains comparable to that of the triplet regimen without isatuximab.
Furthermore, advancements in administration are on the horizon. while currently administered intravenously, studies demonstrate equivalent efficacy with rapid injection. Promisingly, on-body injection options, evidenced by the IKEMA and ICARIA trials, are in development, offering a faster, safer, and subcutaneous route of administration. This will broaden access to quadruplet therapy, enabling smaller institutions to deliver this powerful treatment to more patients.
importantly, achieving a deeper response frequently enough improves overall tolerability. Effective disease control reduces the need for emergency care and frequent doctor visits. Quadruplet therapy also allows for a broader evaluation of side effects, potentially addressing issues not directly related to the myeloma itself, particularly in older patients.
