Innovative Sub-Q Method Could Transform MM Care: Xavier Leleu, MD, PhD

The treatment landscape for multiple myeloma (MM) is evolving rapidly, with care moving beyond quadruplet-based regimens toward increasingly sophisticated immunotherapies. For Xavier Leleu, MD, PhD, head of the Department of Hematology and the Myeloma Clinic at Hôpital La Mileterie in Poitiers, France, and head of the Hematology and Cell Therapy Department at Université de Poitiers, this evolution raises an important question: how can new therapies be delivered in ways that make their benefits accessible and manageable for patients in routine care?

Leleu highlighted the growing role of subcutaneous (sub-Q) administration as one important part of that transition in a recent interview with The American Journal of Managed Care^®. He describes the on-body injector (OBI) as a major improvement in the delivery of sub-Q formulations, particularly for isatuximab. Rather than relying on a manual injection, the device could make treatment administration more convenient and potentially easier to integrate into clinical practice. He was lead investigator on the phase 3 IRAKLIA trial (NCT05405166), data from which was combined with results from the phase 2 IZALCO trial (NCT05704049) and led to the approval of sub-Q isatuximab (Sarclisa; Sanofi) delivered through the CirCLIQ OBI.^1,2

He believes the potential of this approach extends well beyond a single drug. Leleu says he would encourage pharmaceutical companies developing sub-Q immunotherapies to consider OBI technology rather than manual administration. He also expressed the hope that isatuximab and OBI technology will become available to patients with MM worldwide, emphasizing the importance of making advances in treatment delivery broadly accessible.

At the same time, the therapeutic landscape is becoming more complex. Leleu points to a gradual shift from quadruplet-based regimens toward T-cell engagers, cellular chimeric antigen receptor T-cell therapies, and antibody-based bispecific and trispecific therapies. Many of these newer agents are expected to be administered subcutaneously, creating an opportunity to build more streamlined approaches to treatment delivery.

Leleu envisions combinations of sub-Q therapies potentially being delivered through the same type of device. He speculated about a future in which isatuximab and a bispecific could be administered together, potentially simplifying treatment for patients receiving combination immunotherapy. Whether such a system is feasible remains uncertain, he acknowledged, but he is optimistic that continued innovation in device technology will keep pace with drug development. For Leleu, the central opportunity is to ensure that advances in myeloma therapy are accompanied by equally meaningful advances in how those therapies are delivered, particularly as combination treatment becomes increasingly complex.