Dr Richter on Goals for Expanding T-Cell–Redirecting Therapies in Myeloma

"We're on the precipice of moving T-cell redirection into the hands of everyone so that no matter where you are in the [United States]—if not the world—you can get access to these amazing new treatments."

Joshua Richter, MD, an associate professor of medicine in the Division of Hematology and Medical Oncology at the Tisch Cancer Institute, and director of Multiple Myeloma at the Blavatnik Family Chelsea Medical Center at Mount Sinai, discusses the evolution of multiple myeloma treatment in recognition of Myeloma Awareness Month, highlighting the continued goal of expanding T-cell redirection strategies in this patient population.

Richter describes 3 distinct treatment eras in multiple myeloma. The first era was defined by conventional chemotherapy, including oral melphalan, vincristine, doxorubicin, and dexamethasone, which offered limited efficacy. The second era introduced novel agents, including immunomodulatory drugs (IMiDs), proteasome inhibitors (PIs), and anti-CD38 monoclonal antibodies, which significantly improved response rates and survival. The combination of these agents in triplet and quadruplet regimens became and remain the standard of care in the upfront setting.

The current and third treatment era is characterized by T-cell redirection therapies, such as bispecific antibodies and CAR T-cell therapies, he continues. Richter emphasizes the transformative impact of these agents, particularly bispecific antibodies like teclistamab-cqyv (Tecvayli) and talquetamab-tgvs (Talvey), which provide off-the-shelf options compared with patient-specific CAR T-cell therapies. As these therapies move beyond academic centers, efforts are focused on optimizing their administration in community oncology settings to expand accessibility.

Immunotherapy acceptance has increased across oncology, Richter notes, with initial apprehension about checkpoint inhibitors giving way to widespread use in community practices.

Richter underscores the need to refine treatment sequencing, manage associated toxicities, and ensure equitable access to these novel therapies. As research continues to advance, he highlights the potential of T-cell redirection to redefine the treatment paradigm for multiple myeloma.