On Monday, December 8, IMF Chief Medical Officer Dr. Joseph Mikhael, along with IMF Vice President of Patient Support and 24-year myeloma care partner Robin Tuohy, IMF Support Group Leader and 24-year myeloma patient Michael Tuohy, IMF Director of Support Groups Jenn Wieworka DNP, and other patients and support group leaders went live on Facebook to discuss key myeloma research takeaways from ASH 2024.
Here are some of the top takeaways from the Facebook Live Q&A. (EDITOR’S NOTE: Dr. Joe’s overview, live questions, and answers, and Yelak’s closing thoughts have been edited for conciseness and clarity.)
Dr. Joe’s Overview: Five Hottest Topics at ASH 2024
IMF Chief Medical Officer Dr. Joseph Mikhael opened the Facebook Live Q&A with a summary of the five hottest topics at ASH 2024.
1. Smoldering Multiple Myeloma (SMM)
“Multiple myeloma is preceded by precursor conditions. Between the first precursor condition, monoclonal gammopathy of undetermined significance (MGUS) and true myeloma, there is this intermediate condition called smoldering multiple myeloma (SMM). And even SMM is broken into bits —into low-risk, intermediate risk, and high-risk. Perhaps one of the most important abstracts presented at ASH 2024 is a study on high-risk smoldering myeloma where patients were randomized to either just be observed (and watch to see if their disease grows) or be given single agent daratumumab, and there is quite an impressive difference in favor of daratumumab. I’m not sure if we’re quite ready to change our whole practice and treat all high-risk SMM, but it is going to emphasize the need of having an important conversation with our patients.”
2. Frontline Therapy
“We had amazing approvals this year from the U.S. Food and Drug Administration (FDA) for quadruplet therapy (or four-drug combinations). We saw a lot of updated data which helped us understand how we use these quadruplets, and what’s the best way to do it. But we also heard about new combinations coming out front. Some of the drugs we typically use later because they were only approved later, like CAR T-cell therapy and bispecific antibodies, we saw them move into the frontline setting in some of these research trials, particularly in trials using teclistamab—the first bispecific antibody we have in frontline therapy.”
3. Use of MRD (minimal residual disease) Testing
“I was fascinated by how many abstracts were incorporating MRD testing into making decisions, primarily to stop therapy or at least to de-escalate therapy. We’re not quite there yet, comprehensively, but the research was very convincing in a number of settings, where we may be able to treat patients for a period of time, get them to MRD, and then stop therapy and give them my favorite drug—nothing. I say it all the time, we don’t treat myeloma, we treat people to have not just the best quantity but also quality of life.”
4. Novel and New Approaches in Myeloma
“We’ve had CAR T and bispecifics for a number of years, but it’s very exciting to see the new CAR Ts and new bispecifics that are coming. In particular, one CAR T-cell therapy, anito-cel, really looks to be incredibly effective, with less side effects. It’s still a little bit early, we need a little bit of time, it’s not ready for prime time yet, but we’ve seen new CAR Ts, new bispecifics. There’s one in particular that we’re very interested in, where right off the start it’s given only once a month and where we can almost always do it as an outpatient. These are the kind of things we think are not only going to help people control their disease but also give them better quality of life along with a whole set of new drugs to come, which I call CAR T 202 and bispecifics 202.”
5. Less is More
“We’ve historically used a lot of drugs in myeloma for a long period of time. As I commented earlier, MRD may help reduce some of that treatment but we’re starting to see a lot of treatments using a little less of certain drugs and still having great outcomes, if not better outcomes on the patients because they’re easier on their system. One of them is dexamethasone, part of the ‘down with Dex’ movement that we all believe in. We saw a very important trial where they only give dexamethasone for the first two months of therapy and then stop. I think that’s going to be a great template for the future, as we use less of these therapies.”
Live Q&A with Myeloma Voices
Immediately following Dr. Mikhael’s five hottest topics was a live Q&A with patients, care partners, healthcare professionals, and support group leaders. Here, Dr. Mikhael addressed individual-specific questions about diagnosis, prevention, treatments, new therapies, and more.
Rob Salmon, a myeloma patient and co-lead of the San Francisco Bay Area Support raised a question about helping patients think about the next treatment and equally important, how to get to the next one.
“You raise an important question, about how are we best using treatments we have now, and how are we going to get people to that next treatment. I think this is one of those things that we are learning so much about in the treatments we give, especially for things like CAR T and bispecifics, where there is a learning curve. These are tools that we have to harness. One of the messages I give to patients is to have a dialogue with their healthcare team, to talk about any signs or symptoms they’re having. Is there a way that we can optimize the treatment we’re giving? A lot of these drugs were using in combination, we can make some minor adjustments to them. We all want myeloma patients, in some capacity, to connect to a myeloma expert,” responded Dr. Mikhael.
“Getting them to the next therapy is to realize that we don’t save the best for last. We want the best treatments possible cause sadly, with every line of treatment, there are some people who don’t make it to the next line. I know that Yelak will talk about the critical importance of advancing these treatments to the clinic,” Dr. Mikhael further said.
Michael Tuohy, a 24-year myeloma patient who heads the Prospect, Connecticut Support Group, asked about the mechanism of action behind etentamig (ABBV-383).
“This is a newer bispecific that has a few different features to it. On the practical side, it’s different because it’s given once every four weeks from the very start. Secondly, it has either none or maybe one step-up dose. A lot of the other bispecifics have Cytokine Release Syndrome (CRS) as a side effect, but etentamig has less of it. Because of that, the drug is primarily given in an outpatient setting. In terms of what’s different about its mechanism of action, the drug almost attaches to the T cell but doesn’t bind it so tightly. It sticks to the T cell so it engages, but then lets it go so that the T cell doesn’t become a persistently active phenomenon that may lead to CRS or other complications. I think we still need to understand that mechanism a little bit more, but the data was very good from it. Obviously, it’s a little bit further down the line than some of the other bispecifics, but I’m very excited about it this molecule because I think it’s going to be an opportunity to treat patients primarily as an outpatient with less of the side effects we see,” said Dr. Mikhael.
Lots of other compelling questions were raised throughout the Facebook LIVE Q&A, which you can view now.
Closing Thoughts: IMF President & CEO Yelak Biru
In closing, IMF President & CEO and 29-year myeloma patient Yelak Biru shared his own takeaways from ASH 2024:
“There are so many brand-new therapies that are coming to the market. How do we ensure that they actually get to the communities? 80 percent of myeloma patients get diagnosed and treated in the communities but actually die without having access to these therapies. We have to do more and work harder in order for us to be able to do that. As more and more therapies become available, we, as patients and care partners, have to play a bigger role in ensuring that we are able to articulate our quality-of-life needs and communicate what we need from these therapies, which means that, whether we like it or not, we have to elevate our understanding of multiple myeloma and how it directly affects us.”
Yelak also mentioned the IMF’s upcoming 35th anniversary in October 2025. Stay tuned for more of what the IMF has planned for the myeloma community this new year.