EXPERT OPINION ON MULTIPLE MYELOMA TREATMENT
in a low and middle-income country in the Bispecific Antibody Era

Multiple myeloma is a bone marrow-based malignancy with a wide range of consequences because of its direct influence on the bone marrow microenvironment (causing anemia, extensive myelosuppression, and bone lysis) or its indirect effects on the kidney and other organ systems. Pathologically, the high-risk biological phases of multiple myeloma mark the end of the disease's multi-stage development process when clinical damage occurs or is imminent.

The treatment landscape for MM has evolved rapidly in recent years. Although MM remains an incurable disease, significant progress in understanding its pathogenesis has facilitated the development of new, potent target-directed agents. While the overall survival of patients with MM is improving in Brazil, discrepancies remain for patients in the public healthcare system compared to the private.

Americas Health Foundation conducted a virtual meeting with six Brazilian oncologists to provide a comprehensive overview of the treatment landscape for multiple myeloma, highlighting recent advances in novel therapies such as bispecific antibodies and chimeric antigen receptor T-cell therapies.

The resulting paper discusses the efficacy and safety profiles of bispecific antibody therapies like teclistamab, elranatamab, and talquetamab in relapsed/refractory multiple myeloma, particularly in patients with triple-class exposure. Additionally, it explores the results of ciltacabtagene autoleucel (cilta-cel) CAR-T cell therapy and the challenges associated with its administration.

The manuscript also addresses the limitations and disparities in access to these innovative treatments in Brazil, emphasizing the need for targeted efforts to bridge the gap between private and public healthcare systems. It outlines key challenges such as lack of access to advanced diagnostics, limited epidemiological data, restricted access to novel drugs in the public system, and uncertainties around optimal treatment sequencing. The paper concludes by providing recommendations to overcome these limitations, including investing in comprehensive cancer registry systems, expanding access to advanced diagnostics, improving regulatory policies for therapy access in public healthcare, conducting localized research, and addressing disparities in access across different healthcare sectors. The resulting manuscript, "Expert Opinion on Multiple Myeloma Treatment in a Low- and Middle-Income Country in the Bispecific Antibody Era", is under review for publication.

Lead authors: Vania Hungria and Jorge Vaz.