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IMS 2026, Part 3: What Happens When Current Treatments Stop Working?
In our final report from the IMS Annual Meeting, we’re sharing progress related to a key question in myeloma care: What happens when current treatments stop working? As immunotherapies become increasingly important, how can we both develop new ways to overcome resistance, and make it easier for patients to receive treatment?
Research presented over the course of the meeting examined treatments that could expand options for patients after available treatments stop working by building on earlier immunotherapies and/or targeting myeloma in new ways. We also heard how researchers are working to make immunotherapy more accessible by reducing the need for hospital stays.
Several types of immunotherapy are used to treat myeloma. Here are some of the approaches we refer to:
| Type of Immunotherapy | How it Works | Example | Target |
|---|---|---|---|
| CAR T-Cell Therapy | Uses a patient’s own T cells to recognize and attack myeloma | Carvykti | BCMA |
| Bispecific Antibodies | Connect myeloma cells to T cells so the immune system can attack them | Talvey | GPRC5D |
| Antibody-drug conjugates (ADCs) | Deliver a cancer-killing drug directly to myeloma cells | Blenrep | BCMA |
If CAR T fails, can a patient try again?
One small study explored whether a patient can try CAR T-cell therapy a second time after the first CAR T-cell therapy stops working. Twenty-three patients received a second CAR T-cell infusion after their myeloma had progressed following a previous CAR T-cell therapy. Some patients received CAR T directed at the same target as their first treatment, while others switched targets. About 8 in 10 patients responded to the second CAR T-cell therapy and about 4 in 10 had a response that was as deep as or deeper than their response to the first CAR T. Interestingly, using CAR T cells directed at the same target as the first treatment led to deeper responses in some patients, although it did not keep the myeloma from progressing for longer.
Could switching immunotherapies provide another option after treatment stops working?
Researchers followed 116 patients who had previously received a BCMA-targeted immunotherapy. When their myeloma began progressing again, some received another targeted immunotherapy (either one targeting BCMA again or one aimed at a different target, such as GPRC5D or FcRH5). These patients went almost twice as long before their myeloma progressed compared with patients who received other types of treatment. The findings suggest that when one immunotherapy stops working, another may still be effective, even one aimed at a target the patient has been treated against before.
Making access to immunotherapy easier
CAR T-cell therapy and bispecific antibody therapy can require hospital stays and close monitoring, which can limit access to these treatments. Studies presented at the IMS Annual Meeting explored ways to safely provide these therapies without a planned hospital stay, potentially making treatment available to more patients and at more treatment centers.
Bispecific Antibodies
Researchers are exploring whether the first doses can safely be given without a hospital stay. A study of 86 patients evaluated outpatient step-up dosing, in which patients receive several gradually increasing doses of a bispecific antibody before reaching the full treatment dose. Most patients in the study completed step-up dosing without hospitalization, and CRS (an immune reaction that can cause fever and other symptoms) was generally mild. Patients had a caregiver with them, stayed close to the treatment center, and had access to medical care if symptoms developed.
CAR T-cell therapy
Researchers are also looking at whether CAR T-cell therapy can be delivered safely with less reliance on the hospital. A small study of 21 patients evaluated Carvykti without a planned hospital stay, including at treatment centers that were not open 24 hours a day. With daily clinic visits, remote monitoring, 24-hour nursing support, and a caregiver nearby, most patients did not require hospitalization, including patients who developed mild CRS after hours. While more research is needed, this study provides an early model for how Carvykti could potentially be delivered without a planned hospital stay—and may ultimately help more treatment centers offer CAR T-cell therapy.
That wraps up our coverage from IMS 2026, but the conversation doesn’t end here. Join MMRF on September 30 for our post-IMS webinar and October 14 for our livestream, where we’ll take a closer look at key findings from the meeting and what they could mean for patients with multiple myeloma.
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