Multiple myeloma (MM) accounts for 1.8% of all new cancers in the United States but is typically in the top 3 cancers for payer spend. A session at the AMCP 2025 Annual Meeting discussed the challenges of high-cost therapeutics and the expanding treatment pipeline for MM.
The 5-year survival rate is 61%, with a median overall survival of 8.6 years. Incidence of MM in the past 25 years has increased 29%, and the death rate has decreased by 56% in that same period.
Annual Medicare spend on 14 MM drugs increased from $2 billion in 2013 to $10.2 billion in 2021. Costly therapeutics such as chimeric antigen receptor (CAR) T-cell therapies and bispecific antibodies are drivers of high costs, as are:
- The use of 3- or 4-drug combination regimens
- Moving higher-ticket drugs such as CAR T-cell therapies into earlier lines of treatment (eg, from fifth line to second line)
- Patients undergoing transplantation
There are also limited data on the best sequencing of MM therapeutics.
In 2024, the FDA recognized measurable residual disease negativity complete response as an appropriate early surrogate end point in MM trials. The presenters discussed how this new surrogate end point may affect the field, particularly the potential for manufacturers to submit requests for accelerated approval of a therapeutic at an earlier time point.
The presenters then discussed the MM treatment pipeline.
The DREAMM-7 and DREAMM-8 clinical trials signify the “reintroduction” of belantamab for relapsed or refractory MM. Both trials met primary end points showing statistically significant and clinically meaningful improvements in progression-free survival with belantamab combinations in this patient population. However, ocular toxicity remains a concern with this treatment.
The phase 2 LiNKER-MM1 study of linvoseltamab, an investigational bispecific antibody, showed an overall response rate (ORR) of 71% among 282 patients with relapsed or refractory disease after 3 or more lines of treatment.
A multi-institution, phase 2 study is assessing the noninferiority of limited-duration teclistamab for relapsed or refractory MM. Patients who achieve a very good partial response or better may discontinue treatment and undergo monthly monitoring for 2 years. Patients can resume treatment with teclistamab if disease progression is detected. The researchers will assess the rate of treatment failure 6 months after discontinuation of teclistamab and compare that with findings from historical control groups that received continuous therapy.
A phase 2 study assessing teclistamab and talquetamab, both bispecific antibodies, showed an ORR of 92% in heavily pretreated patients.
There are also various CAR T-cell therapies in clinical trials, including ALLO-715, which induced an ORR or 70.8%, and P-BCMA-ALLO1, which resulted in a 90.0% ORR in the intention-to-treat cohort and a 100.0% ORR in B-cell maturation antigen–naive patients.
This session was supported by an independent medical education grant from GSK.
Reference
Bobolts LR, Pozotrigo M, Wojcicki S. Charting a better path in managing multiple myeloma: overcoming challenges and driving solutions. Presented at: AMCP 2025; March 31-April 3, 2025; Houston, TX. Session D1.
