When Myeloma Returns, a New Treatment Is Changing the Odds
- A treatment first approved for heavily pretreated myeloma may be moving earlier. TALVEY was approved for heavily pretreated patients — this trial showed strong results when TALVEY-based combinations were used earlier in the disease course.
- Deep remissions were common. About half of patients receiving TALVEY-based combinations had no detectable myeloma on highly sensitive testing.
- It preserves future options. Using TALVEY now keeps other advanced therapies available later.
- Side effects were generally manageable in the trial, but they require careful monitoring by a myeloma team. Taste changes, skin or nail issues, and balance problems — different from chemo, and usually controllable.
A Disease Being Transformed — Right Now
Multiple myeloma treatment has changed more in the past few years than in the previous two decades. A new generation of drugs — including bispecific antibodies and CAR T-cell therapies — is producing results that weren’t imaginable not long ago. Some experts are beginning to talk about the possibility of very long remissions, but multiple myeloma is still usually treated as a chronic, relapsing cancer.But one group of patients has largely been left out of this progress: people whose myeloma comes back after their first treatment. They’re not newly diagnosed, but they haven’t exhausted all options either. For years, this group has had few strong choices — and limited access to the newer therapies making headlines. A new clinical trial called MonumenTAL-3 was designed specifically to change that.
Read MoreFrom Last Resort to Earlier Hope: TALVEY’s Story
The drug talquetamab (TALVEY) earned FDA approval in 2023 — but only for patients who had already failed at least four prior treatments. It was a last resort, and even there, it worked. That success raised an important question: what if TALVEY could help patients much earlier, before they’ve been through so many rounds of treatment? MonumenTAL-3 tested exactly that. Researchers gave TALVEY in combination with other myeloma medicines to patients who had relapsed after just one prior treatment — and compared results with standard therapy.
What the Study Found
The results were striking. Two years after starting treatment, about 8 out of 10 patients on a TALVEY-based combination were still living without their cancer getting worse — compared with about 5 out of 10 on standard therapy.
“Patients who received the talquetamab (TALVEY)-based combinations had about a 70% lower risk of their myeloma progressing or causing death,” said Dr. Al-Ola Abdallah. “That’s a substantial improvement and suggests these treatments have the potential to keep patients in remission longer.”
Many patients responded so well that even the most sensitive lab tests — ones that can detect a single myeloma cell among a million healthy ones — found no trace of cancer. Doctors call this MRD-negative, and it’s one of the strongest signs that a treatment is working.
“An MRD-negative complete response rate above 50% in patients whose myeloma has already returned is something we’ve rarely seen outside of CAR T-cell therapy,” said Dr. Ehsan Malek of Roswell Park Comprehensive Cancer Center. “We’re seeing stronger responses, more patients reaching very deep remissions, and longer periods without disease progression.”
Why Timing Matters
One reason physicians are especially interested in these findings is that getting a very deep remission early may change a patient’s entire long-term trajectory. There’s growing evidence that the sooner myeloma is pushed into a deep remission, the longer it may stay there.
TALVEY also works differently from many other newer therapies. It targets a protein called GPRC5D, while other advanced treatments — including certain CAR T-cell therapies — target a different protein called BCMA. Using TALVEY earlier preserves those BCMA-targeted options for later if they’re ever needed. In a disease where sequencing treatments strategically matters enormously, that flexibility is valuable.
“This is one of the more convincing relapsed myeloma studies we’ve seen in recent years,” Dr. Malek said. “Newer immune-based therapies may provide not only longer remissions, but also deeper responses — with side effects that are different from traditional chemotherapy.”
This does not mean TALVEY is the best option for every patient after the first relapse, but it gives doctors another important treatment strategy to consider.
Questions for Ask Your Doctor:
- If my myeloma has come back after one prior treatment, am I eligible for a TALVEY-based regimen?
- Is TALVEY approved for my situation, or would this still be considered off-label or available only through a clinical trial?
- Would I be a better fit for TALVEY plus daratumumab, or for a three-drug combination that also includes pomalidomide?
- How does my prior treatment history affect whether TALVEY is a good option for me?
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