Advancements in Multiple Myeloma Therapies and Operational Insights in Oncology Clinical Trials

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Multiple myeloma (MM) is characterized by abnormal plasma cell proliferation and monoclonal immunoglobulin production, often presenting with hypercalcemia, renal dysfunction, anemia, and bone lesions. The introduction of proteasome inhibitors, immunomodulatory agents, and anti-CD38 monoclonal antibodies has revolutionized treatment, extending survival rates. Among recent advances, bispecific antibodies (bsAbs) and chimeric antigen receptor (CAR) T-cell therapies have reshaped the treatment landscape, offering new options for relapsed/refractory (R/R) MM.

In the cover feature on page 10, Amir Ali, PharmD, BCOP; Kevin Le, PharmD, BCOP; Tanjia Toma, PharmD candidate; Soumar Haddad, PharmD candidate; Fleuri Dindar, PharmD candidate; and Bryan Ceballos, PharmD candidate, provide an updated overview of the role of BCMA-directed therapies following the 2024 American Society of Clinical Oncology Annual Meeting and 29th European Hematology Association Congress, particularly looking at bsAbs and CAR T-cell therapies for R/R MM. Among BCMA-directed bsAbs, BCMA-targeting bsAbs teclistamab (Tecvayli; Janssen Biotech) and elranatamab (Elrexfio; Pfizer) demonstrate similar efficacy and safety profiles. However, elranatamab offers logistical advantages, including shorter hospitalization and fixed dosing. Talquetamab, with its unique GPRC5D target, provides high response rates and flexibility for sequential or combination use. While CAR T-cell therapies show unprecedented efficacy, their one-time administration contrasts with the continuous nature of bsAbs. Optimal sequencing between bsAbs and CAR T-cell therapy remains an area of ongoing research to maximize therapeutic benefit.

In original research on page 15, Kaycey Pearce, PharmD; and Jennifer Murphy, PharmD, BCOP, BCPS, focus on operational challenges within oncology clinical trials. The authors analyze factors influencing infusion appointment duration and arrival-to-chair time for oncology clinical trial patients at UC Davis Comprehensive Cancer Center in Sacramento, California, from 2019 to 2022. Despite initial hypotheses, most intrinsic and extrinsic variables, such as study type, pharmacokinetic requirements, and am/pm scheduling, showed no statistically significant impact on appointment duration or wait times. However, phase 3 trials and appointments involving multiple investigational products (IPs) significantly increased duration, highlighting these as key areas for improvement. Age was inversely associated with appointment duration, possibly reflecting less intensive protocols for older patients. The findings underscore the need for targeted strategies in multi-IP trials and advanced trial phases to enhance efficiency.

The treatment landscape for MM continues to evolve with the integration of innovative therapies such as bsAbs and CAR T-cell therapies. Continued research is essential to optimize the use and sequencing of these therapies, ensuring maximum patient benefit in this dynamic treatment era. Further, operational improvements in oncology clinical trials, particularly for complex protocols, remain critical to advancing patient care.