Targeting BCMA in patients with relapsed/refractory multiple myeloma in 1 to 3 prior lines of therapy
Doris K Hansen1, Maria-Victoria Mateos2, Luciano J Costa3
1Department of Blood and Marrow Transplantation and Cellular Immunotherapy, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL.
Abstract:
The treatment landscape for multiple myeloma is evolving rapidly with the integration of novel B-cell maturation antigen (BCMA)-directed therapies. In the early-relapse setting (1-3 prior lines of therapy), several practice-changing phase 3 trials have reported results in the past 2 years, including chimeric antigen receptor T-cell therapies, bispecific antibodies, and antibody-drug conjugates. These studies offer exciting new options for clinicians but also introduce complexity due to differences in patient populations, trial designs, and real-world applicability. We synthesize data from trials exploring BCMA-directed immunotherapy in the early-relapse setting, explore nuances in trial characteristics and their implications for treatment selection, and discuss treatment decision determinants, including age, fitness, comorbidities, treatment exposure, and access to therapy. We subsequently discuss how emerging BCMA-directed therapy affects decision-making in several common scenarios. For each of these common scenarios, we explore applicability and limitations from the clinical trials, treatment access, and logistical considerations and the importance of shared decision-making.
Insights
Novel therapies targeting BCMA are transforming multiple myeloma treatment. This review synthesizes data from recent trials to guide clinical decisions in early relapse, considering patient factors and access to these advanced treatments.
Area of Science:
- Oncology
- Immunotherapy
- Hematology
Background:
- The treatment of multiple myeloma is rapidly evolving with new therapies.
- Bispecific antibodies, CAR T-cell therapies, and antibody-drug conjugates targeting BCMA are now available.
- These novel agents offer new options but add complexity to treatment selection.
Purpose of the Study:
- To synthesize data from phase 3 trials of BCMA-directed immunotherapies in the early relapse setting.
- To explore trial characteristics and their impact on treatment selection for multiple myeloma.
- To discuss factors influencing treatment decisions and shared decision-making.
Main Methods:
- Systematic review and synthesis of data from recent practice-changing phase 3 clinical trials.
- Analysis of patient populations, trial designs, and real-world applicability of BCMA-directed therapies.
- Discussion of treatment decision determinants including age, fitness, comorbidities, and access.
Main Results:
- Several BCMA-directed therapies, including CAR T-cells, bispecific antibodies, and ADCs, show efficacy in early relapse multiple myeloma.
- Trial data highlight variations in patient characteristics and designs, impacting generalizability.
- Treatment decisions are influenced by patient-specific factors and logistical considerations.
Conclusions:
- BCMA-directed therapies represent a significant advancement in managing early relapse multiple myeloma.
- Careful consideration of clinical trial data, patient factors, and access is crucial for optimal treatment selection.
- Shared decision-making is essential for integrating these novel therapies into clinical practice.
Related Concept Videos
02:57Targeted Cancer Therapies
There are several types of targeted therapies against specific...
02:50Combination Therapies and Personalized Medicine
The combination of the drug acetazolamide and sulforaphane is a good example of combination therapy to treat cancer. The cells in the interior of a large tumor often die due to the hypoxic and...