Characteristics and utilization of the three BCMA-targeted therapies in multiple myeloma

Recent advancements in the treatment of multiple myeloma have significantly improved patient outcomes, primarily due to the introduction of various therapeutic modalities. This review focuses on three BCMA-targeted therapies: anti-BCMA CAR-T cell therapy, bispecific antibody (BsAb) therapy, and antibody-drug conjugate (ADC) therapy. BCMA, a membrane-bound protein predominantly expressed on myeloma cells, presents a promising target due to its limited expression in normal tissues, minimizing off-target toxicity. We explore the characteristics, efficacy, and safety profiles of these therapies, highlighting the differences in overall response rates and potential adverse effects. Anti-BCMA CAR-T therapies, such as idecabtagene vicleucel (ide-cel) and ciltacabtagene autoleucel (cilta-cel), exhibit varying response rates and durability, with cilta-cel showing a plateau phase suggesting potential long-term remission. In contrast, BsAb therapies like teclistamab and elranatamab provide off-the-shelf treatment options but may lead to T-cell exhaustion. ADC therapy, represented by belantamab mafodotin, poses unique challenges, particularly concerning ocular toxicity. Furthermore, treatment sequencing is critical, as prior exposure to one therapy can influence the efficacy of subsequent treatments. This review emphasizes the necessity of assessing BCMA expression and T-cell exhaustion before initiating therapy, and advocates for carefully constructed treatment regimens to optimize outcomes for patients with multiple myeloma.