Oral Iberdomide May Widen Myeloma Access: Mateo Mejia Saldarriaga, MD

Bispecific antibodies and chimeric antigen receptor (CAR) T-cell therapy may lead the multiple myeloma field, but oral therapies such as iberdomide could have a larger effect on access for patients worldwide, according to Mateo Mejia Saldarriaga, MD, hematologist and oncologist at Weill Cornell Medicine and NewYork-Presbyterian. In an interview with The American Journal of Managed Care^®, Mejia Saldarriaga discussed the role of nonimmunotherapy regimens, global access, and clinical trial participation.

Why Triplet Regimens Remain Relevant

Bispecifics and CAR T-cell therapy appear to be the clear winners in relapsed myeloma, but they are not suitable for every patient, Mejia Saldarriaga said. Patients aged 85 years, or those with significant chronic obstructive pulmonary disease, may face an infection risk that makes these therapies impractical.

For those patients, other second-line regimens and triplets are still used regularly. Mejia Saldarriaga called them completely reasonable options as long as clinicians discuss the risks and benefits with patients.

How Iberdomide Compares With Pomalidomide

Iberdomide can be useful well beyond late lines of therapy, Mejia Saldarriaga said. Although iberdomide and pomalidomide have not been compared head to head, iberdomide appears to have much higher potency and can show clinical activity in patients whose disease is refractory to lenalidomide or pomalidomide.

"To me, it just seems like a much better option than the standard we have," Mejia Saldarriaga said.

Iberdomide is an oral therapeutic take on days 1 to 21 of a 28-day cycle. That makes it far easier to deliver to patients in rural parts of the US or in other countries than a bispecific or CAR T-cell therapy, according to Mejia Saldarriaga.

Mejia Saldarriaga, who is from Colombia and stays in close contact with colleagues there, said widespread CAR T availability in Latin America is unlikely within the next 10 years. "In my mind, what is going to happen first? Is it going to be CAR T and bispecifics, or maybe a pill that we can do safely at home? I think the latter," Mejia Saldarriaga said.

Although Mejia Saldarriaga remains enthusiastic about immunotherapy, work on other approaches needs to continue because "one size does not fit all our patients."

Why Patients Should Consider Clinical Trials

The myeloma field is moving quickly, with several approvals in the past 2 to 3 years and more expected, Mejia Saldarriaga noted. For patients who are eligible, clinical trials should always be part of the conversation. Trials help researchers better understand the disease, and they give patients access to combination treatments that may become standard practice within 1 or 2 years.

Mejia Saldarriaga encouraged patients to discuss trial options and not be afraid of the words "study" or "trial," noting that safety is the main goal of every study.

"What I do is I always tell my patients I do the relative test," Mejia Saldarriaga said. "Would I put my mom or my aunt in this trial? And that implies that you need to make sure that under all circumstances you're going to be getting as good or even better than the standard of care that you will do out of the trial."