Novel immunotherapies
In late 2025, the first quadruplet treatment for newly diagnosed myeloma patients ineligible for a stem cell transplant was approved by NICE for use across the UK. IsaVRD is a combination of the monoclonal antibody Isatuximab (Sarclisa ®), with bortezomib, lenalidomide and dexamethasone.
Monoclonal antibodies represent a type of immunotherapy that work by making myeloma cells more visible to the immune system by attaching to proteins found on the surface of myeloma cells. Isatuximab binds to the protein CD38, allowing the immune system to locate and kill the myeloma cells.
Efficacy
The decision to recommend IsaVRD is based on the data from the phase 3 IMROZ clinical trial. In the trial, IsaVRD delivered some of the deepest responses reported for this patient population with 58% of the people receiving IsaVRD reaching minimal residual disease negativity and 46% having sustained minimal residual disease negativity for at least 12 months.
The trial also showed it has the potential to lengthen progression-free survival with 63% of the patients on IsaVRD continuing to be progression-free after five years.
Administration
Isatuximab is usually given intravenously in 4 weekly cycles.
Side effects
| Treatment | Potential side effects |
|---|---|
| Isatuximab | Low bloods counts, increased risk of infection, fever, gastrointestinal disturbances, cataracts, reduced appetite or weight loss, feeling shortness of breath, anaemia & bleeding, fatigue, infusion reaction |
Use of isatuximab increases the risk of tumour lysis syndrome (TLS) which can cause an irregular heartbeat, muscle cramps, kidney problems and/or seizures. Drinking plenty of fluids or medication may be given to some patients to prevent TLS. Isatuximab is not recommended in those who are pregnant and effective contraception should be used during treatment and for the following 5 months.