Commentary

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Different Roads, Same Goal: Dr Joseph Mikhael Explores Early R/R Multiple Myeloma Treatment Strategies in the US, Europe

Joseph Mikhael, MD, MEd, FRCPC, FACP, of the International Myeloma Foundation, HonorHealth, and TGen, notes that US physicians have more flexibility when treating patients with early relapsed/refractory multiple myeloma, whereas those in Europe must follow stricter protocols.

Joseph Mikhael, MD, MEd, FRCPC, FACP, chief medical officer of the International Myeloma Foundation, professor at the Translational Genomics Research Institute (TGen), and myeloma research director and consultant hematologist at HonorHealth, explains that US patients with early relapsed/refractory multiple myeloma benefit from more flexible, varied options, whereas European physicians must follows stricter protocols. However, both regions aim to optimize patient outcomes and learn from each other.

This topic was further explored during the session, "Individualized Treatment in Early Relapse for Patients with Relapsed/Refractory Multiple Myeloma" at the European Hematology Association (EHA) 2024 Congress in Madrid, Spain; Mikhael discussed the US patient experience during his presentation, "How I Treat Relapsed/Refractory Multiple Myeloma in Early Lines: The US Experience."

Transcript

How do the treatment strategies for early relapsed/refractory multiple myeloma differ between the US and Europe?

There are always differences between the US and, frankly, the rest of the planet when it comes to early relapse myeloma. We have to be very grateful in the US that we have options not only guided by phase 3 trials but, very often, by other approvals that we have based on what's on the NCCN [National Comprehensive Cancer Network] guidelines. The NCCN guidelines tend to be a huge laundry list of choices, which is great for us and our patients—most importantly for our patients—because it does give them different opportunities.

The difference between the US and many other countries, in particular here in Europe, is that they don't have that same flexibility; they have to use drugs very much on purpose as they were done in a phase 3 clinical trial, occasionally a phase 2 clinical trial, and that approval is much more strict as opposed to the flexibility that we have.

It typically means that, in the US, we have more combinations, more choices, more opportunity to switch in, let's say, carfilzomib for bortezomib or pomalidomide for lenalidomide, when the study may have been done with the other similar drug.

That being said, our colleagues here in Europe and around the world are outstanding myeloma physicians and treaters, and they've learned to use what they have most effectively. It is very important to recognize in the world myeloma community that we can all treat myeloma the same way, but we want to optimize what choices we have, what things we have in our toolbox, to use them most effectively for our patients.

Conversely, what commonalities exist between these strategies?

I think the commonality of our strategies between the US and Europe, well, first and foremost, is that we all want the best for our patients, right. I think in a world where we're not curing myeloma in a large fraction of patients, in a world where we don't have perfect drugs, every drug has a challenge and every drug has a potential benefit, we learn together and from each other in how to optimally manage our patients. We do follow the evidence, we do want our patients' quality of life at stake.

So, in that way, I would actually argue we have much more in common than we do that is not in common, but it is very much dependent on what is specifically available, another reason why we need to advocate so strongly for greater access to therapies across the world.

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