After the MAJESTEC-3 results, what is your approach to choosing between tec-dara vs. cilta-cel versus another triplet for multiple myeloma in first relapse?

This is an excellent question, and literally a million-dollar question for various companies involved. It's worth noting that the US FDA can change the package insert at will (and has done so) compared to what the trials did, so there's no guarantee as of yet that Tec-Dara (based on MajesTEC-3) will...

MajesTEC-3 studied Teclistamab + Daratumumab compared to standards of care (Dara-Pd or Dara-Vd) in relapsed myeloma with 1-3 prior lines of therapy. The HR for PFS was an impressive 0.17, and the 36-month PFS for all comers in the Tec-dara arm was a whopping 83.4%! The HR was similar across most sub...

I agree with @Dr. First Lastthat this is an expensive question and do appreciate his comparison between the two options.

I'm certain that the published MajesTEC-3 data did not represent the true toxicity profile. IG replacement was only required partway through enrollment, limiting the clarity of wha...

I agree with @Dr. First Last's thoughtful and nuanced framework. I particularly appreciate the emphasis on shared decision-making, access considerations, and the concept of “time toxicity,” which I think will matter greatly in real-world practice as these options move earlier.

In my practice, the ch...

A difficult question! In fit patients, I do still use cilta-cel first. Given difficulties manufacturing viable and effective CAR-T cells after bispecific antibody exposure, I think it is likely that the sequence of CAR-T -> bispecific antibody would result in better PFS2 than the inverse sequence. F...

The data for T-cell engagers in myeloma is extremely compelling, and therefore, currently, I would choose either a bispecific antibody or a CAR-T approach over a triplet combination. In my clinical practice, I have been impressed with the deep responses, long remissions, and, importantly, good quali...

All patients should be considered for a BCMA-directed therapy at the time of their first relapse. Ideal options include either CiltaCel or teclistamab/daratumumab or teclistamab monotherapy. The choice between CAR-T and bispecific antibody depends on patient profile, disease characteristics, and rel...