Dr. Mateo Mejia Saldarriaga, a hematologist and oncologist affiliated with Weill Cornell Medicine and NewYork-Presbyterian, suggests that iberdomide, an oral therapy, could transform multiple myeloma treatment accessibility on a global scale. During an interview, he emphasized the importance of nonimmunotherapy approaches, improving patient access, and encouraging participation in clinical trials.
Mateo Mejia Saldarriaga highlights that while bispecific antibodies and CAR T-cell therapy are at the forefront of multiple myeloma treatment, they may not suit all patients. Those aged 85 or older, or with severe chronic obstructive pulmonary disease, face heightened infection risks, making these therapies less practical for them.
For such patients, Mejia Saldarriaga notes that second-line treatments and triplet regimens remain viable options. He emphasizes that these choices are reasonable as long as doctors thoroughly discuss the potential risks and benefits with their patients. These alternatives are particularly important for individuals who cannot undergo bispecific or CAR T-cell therapies.
Mejia Saldarriaga points out that iberdomide can be beneficial even in earlier stages of treatment, not just as a last resort. While it hasn’t been directly compared to pomalidomide, iberdomide shows greater potency and effectiveness in patients whose disease resists lenalidomide or pomalidomide.
Iberdomide is an oral therapeutic taken on days 1 to 21 of a 28-day cycle. This 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. He, 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.
Mejia Saldarriaga remains enthusiastic about immunotherapy, but work on other approaches needs to continue because one size does not fit all patients. He encouraged patients to consider clinical trials, which help researchers better understand the disease and give patients access to combination treatments that may become standard practice within 1 or 2 years.
Mejia Saldarriaga noted that safety is the main goal of every study and encouraged patients to discuss trial options and not be afraid of the words “study” or “trial.” He uses a relative test to determine whether a trial is suitable for his patients, asking himself if he would put his mom or aunt in the trial.
