Cancer Therapy AdvisorTreatment of Relapsed or Refractory Multiple Myeloma with BCMA Bispecific Antibodies

BCMA-targeted Bispecific Antibodies Offer Promising Efficacy and Manageable Toxicity for Relapsed/Refractory Multiple Myeloma

This conversation with Shaji Kumar, MD, of the Mayo Clinic in Rochester, Minnesota investigates the use of BCMA-targeted bispecific antibodies, specifically teclistamab, for the treatment of relapsed or refractory multiple myeloma (R/R MM). The findings suggest that bispecific antibodies may offer a new and effective option for managing this complex disease, with manageable toxicity profiles compared to other immunotherapies.

Key Points:

• BCMA as a Target for R/R MM: BCMA is highly expressed on malignant plasma cells in R/R MM, making it an attractive target for immunotherapy.
• Mechanism of Action: Bispecific antibodies like teclistamab work by binding to BCMA on tumor cells and CD3 on T cells, triggering T cell-mediated tumor cell death.
• Efficacy of Teclistamab: In heavily pretreated R/R MM patients, teclistamab demonstrated an overall response rate of 63%, with a median progression-free survival of 11.3 months and median overall survival of 18.3 months.
• Safety Profile: Teclistamab has a manageable toxicity profile compared to CAR T-cell therapy, with common side effects including cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). The risk of infections is also a concern.
• Combination Therapy: Bispecific antibodies like teclistamab can be effectively combined with current standard care treatments for R/R MM, potentially improving outcomes.
• Future Directions: Researchers are exploring the use of combination therapies with BCMA-targeted agents earlier in the treatment timeline, even for newly diagnosed patients.

“Unlike CAR T-cells, which necessitate T-cell collection and storage for modification before reinfusion, bispecific antibodies are readily available off the shelf.”
– Shaji Kumar, MD

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