An Explosion of Agents for Myeloma Treatment

Prerna Mewawalla, MD, a hematologist at Allegheny Health Network, explains how the treatment landscape for multiple myeloma is growing.

Recently, the introduction of bispecific antibodies has excited hematologists, due to the significant efficacy and tolerability shown with these agents in the clinical trial setting. Teclisatamab-cqyv (Tecvayl), a bispecific B-cell maturation antigen CD3 T-cell engager was granted approval in 2022 for the treatment of adults with relapsed or refractory multiple myeloma who were previously treated with at least 4 prior lines of therapy, including proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody.

Moreover, bispecifics can be an alternative to chimeric antigen receptor (CAR) T-cell therapy, says Mewawalla. Another key regimen for multiple myeloma is the use of 4-drug combination in the frontline setting. For example, daratumumab (Darzalex) plus lenalidomide (Revlimib), bortezomib (Velcade), and dexamethasone (dara-RVD) appears to be a promising treatment option for patients with multiple myeloma.

Transcript:

0:07 | We have so many new agents that have been approved for myeloma or are in the process of it. The ones that I am most excited about are our bispecifics. The first one, which was recently approved, was teclisatamab, with response rates of over 60% and with the progression-free survival [PFS] of over a year. Prior to the teclisatamab, all the other single agents, which were approved in this space, generally had a response rate of around 30%. For a single agent to have a response rate of over 60% in a patient population that is so heavily pretreated is just amazing.

0: 48 | The other advantage of having teclisatamab is that we also have a CAR T shortage, and a lot of our patients were not able to get to CAR T. Having teclisatamab has also helped these patients who will normally have no other option to received something else. That is something I'm excited about.

1:08 | Another drug, which is not technically new, but it has been practice-changing, is using quadruplets upfront. We’re using daratumumab plus lenalidomide [bortezomib, and dexamethasone, or dara-RVD, in the upfront setting in more and more patients to get deeper responses.