The sequence of therapies like bispecifics and CAR-T critically impacts future options and outcomes. This necessitates early, strategic collaboration between community oncologists and academic centers to plan a patient's entire treatment journey, not just the next immediate step.
In combination with bispecifics like teclistamab, daratumumab not only targets myeloma cells but also enhances the partner drug's efficacy by reducing immunosuppressive T-regulatory (Tregs) and B-regulatory (Bregs) cells, making the primary therapy more effective.
For older, transplant-ineligible patients, well-tolerated, long-term regimens from trials like CFIUS shift the treatment goal. Success is defined as managing myeloma so effectively that patients are more likely to die of other age-related causes, effectively outliving their cancer.
While scientifically novel, the primary advantage of in vivo CAR-T therapy is its potential to overcome the significant logistical barriers of traditional CAR-T. By simplifying the process to a single injection, it could democratize access for patients far from specialized academic medical centers.