Understanding Multiple Myeloma Treatment Patterns and Sequencing With Robert Rifkin, MD, FACP

This podcast episode was recorded live by Oncology Data Advisor and ConveyMED at the 2022 ASH Annual Meeting in New Orleans.

Oncology Data Advisor: Welcome to Oncology Data Advisor. Today, we're at the ASH Annual Meeting, and I'm here with Dr. Robert Rifkin. Dr. Rifkin, thank you so much for joining today.

Robert Rifkin, MD, FACP: Thank you very much, and I'm delighted to be here. I'm Robert Rifkin, I'm a Medical Oncologist at Rocky Mountain Cancer Centers in Denver, Colorado, and I'm the Disease Lead for Multiple Myeloma in The US Oncology Network. Aside from ASH, I also am the Medical Director of Biosimilars for McKesson.

Oncology Data Advisor: Today, we're talking about your study on the impact of COVID-19 on treatment patterns and management of multiple myeloma. Would you like to tell us about the study and the background for it, and why you decided to make it your focus?

Dr. Rifkin: Well, I think this is a very interesting study because as all of you know, it's based on the Connect^® MM Multiple Myeloma Registry that we actually started back in 2009. And in our first cohort of patients, we accrued about 1,500 participants. The next cohort in the registry was 1,500 more. What was interesting is the way things spread out at the very start; we didn't have nearly the number of multiple myeloma drugs that we have now. In the second cohort, we started to reflect some novel agents. Around all of this came the emergence of daratumumab, and as all of you know, daratumumab is a monoclonal antibody directed against CD38, a target in malignant plasma cells.

When daratumumab first came out, it was an intravenous infusion that took a lot of time, and we and others have published how to split the first dose and then keep right on going. The regimen for daratumumab is eight weekly doses, then eight doses every other week, and then monthly. You don't really think a lot about that until you get a pandemic when nobody would like to come to your office, and we might actually not even like to see you. And as you get people on daratumumab, again, a very active drug, the convenience factor becomes very important. So, when patients got to the once-monthly dose, that was convenient; it was safe, effective, and non-toxic. What we've shown in our study were patterns of uptake and changes in utilization of daratumumab.

And then if you layer on top of that, with some of the oral regimens we're using to treat myeloma now, it's kind of like the perfect pandemic-friendly regimen. Once-a-month daratumumab, take your oral pills, and you have a very active regimen against myeloma. I don't think there is necessarily an increase in COVID-related deaths. If you look at every study presented at this meeting, they all have footnotes about COVID-related deaths or COVID-related illnesses or comorbidities. But Connect MM is an ideal vehicle to take a nice look back at changing treatment patterns in the patients' myeloma journey, if you will.

Oncology Data Advisor: Great, thank you. What do you think are the implications for this study? How can it be used in practice?

Dr. Rifkin: Well, the implications, I think, are interesting. It's actually hard now to find a myeloma patient who's beyond the second line who hasn't seen daratumumab. There are other anti-CD38 monoclonals, in particular isatuximab, that are beginning to emerge. And just like daratumumab, it will have a subcutaneous (SubQ) formulation. The SubQ formulation of daratumumab really revolutionized how we do things because the patients are literally only in clinic for 15 minutes. You get labs, you get your infusion. After the first few doses, you don't wait, you just go home. So, people are looking at not only alternative ways to deliver these, but now what we'll be able to look at in Connect going forward, in our next cohorts of patients, are folks that have been exposed to all of the newer things, whether it's CAR T cells, antibody-drug conjugates, new monoclonal antibodies, bispecifics, or brand-new classes of drugs.

So, I think it's a really exciting time for multiple myeloma research, and we need to, with the aid of Connect and other data-gathering exercises, figure out the right sequence and the right exposures. Now, it's exciting because we can follow people that have stringent complete responses (CRs) and we can start to look at minimal residual disease (MRD) and make MRD negativity the new gold standard. And all of that's changed dramatically over the time course that Connect's been going. So, it's a really good registry. You can see the whole history of multiple myeloma and its treatment.

Oncology Data Advisor: That's great. Anything else you'd like to share about the other myeloma abstracts that you've seen presented here?

Dr. Rifkin: I think at this meeting there are a ton of myeloma abstracts, a ton of things on bispecific antibodies. Cytokine release syndrome and immune effector cell–associated neurotoxicity syndrome (ICANS) are making the headlines everywhere, but I think what you're going to see is really what's happened with all of our other drugs, where we're going to move towards outpatient administration, because the hospitals are overwhelmed. We don't have staff to cover all the beds—lots of "we don't haves." So, the more we can keep people out of the hospitals and give safe, effective therapy, the better we're going to do.

Oncology Data Advisor: That's great. Well, thank you so much for talking with us about this today. It was really interesting.

Thank you for listening to this podcast, recorded live at the 2022 ASH Annual Meeting by Oncology Data Advisor and ConveyMED. For more expert perspectives on the latest in cancer research and treatment, be sure to subscribe to the podcast at conveymed.io and oncdata.com. Don't forget to follow us on social media for news, exclusive interviews and more.

About Dr. Rifkin

Robert Rifkin, MD, is a Board-Certified Medical Oncologist and Hematologist at the Rocky Mountain Cancer Centers in Denver, Colorado. As well, he is the Medical Director of Biosimilars at McKesson and an Associate Chair of Hematology Research and Disease Lead for Myeloma for The US Oncology Network. Dr. Rifkin specializes in malignant and benign hematology, which includes subspecialties in multiple myeloma, coagulation disorders, and biosimilars.

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Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.