Discussing the Treatment Options for RRMM Following Progression After BCMA CAR T Therapy

Physician Summary: Treatment Options After Progression Following BCMA-Directed CAR T Therapy

After progression on BCMA-directed CAR T therapy, several treatment options have demonstrated efficacy in relapsed/refractory myeloma:

• Selinexor-based regimens: Effective in CAR T–refractory myeloma (BOSTON trial data). Selinexor can help control disease and may enhance subsequent CAR T efficacy.
• BCMA-targeted therapies:
• Teclistamab, elranatamab, and belantamab mafodotin (immune-engager therapies) have shown promise as next-line therapies following BCMA-directed CAR T relapse.
• Talquetamab: A GPRC5D-targeted bispecific antibody that has shown potential in patients with relapsed BCMA-directed CAR T therapy.
• Cytotoxic chemotherapy: Can be considered for aggressive disease or as a bridge while awaiting other treatments but carries the risk of T-cell suppression.
• CELMoDs: Novel immunomodulatory drugs (IMiDs) may enhance CAR T functionality and could offer benefit in post-CAR T relapse settings.

Key Takeaway: Post-BCMA CAR T progression requires careful consideration of available therapies like bispecific antibodies, selinexor, and novel CELMoDs to manage disease and potentially enhance response to future treatments.