Dr Grajales-Cruz on Future Research Directions With Teclistamab in R/R Multiple Myeloma

Ariel Grajales-Cruz, MD, assistant member, Department of Malignant Hematology, Multiple Myeloma Section, Moffitt Cancer Center, discusses next steps for research elucidating the role of teclistamab (Tecvayli) monotherapy for patients with relapsed/refractory multiple myeloma.

At the 2023 ASH Annual Meeting, findings were presented from a retrospective, single-center study of the real-world efficacy of teclistamab in heavily pretreated patients with multiple myeloma who had progressed on a prior BCMA-directed therapy. The overall response rate (ORR) with teclistamab in the real-world setting was 52.8%, with a complete response rate of 44.5%. Furthermore, the median progression-free survival (PFS) was 8 months. These ORR and PFS rates were comparable with those observed in patients without prior BCMA therapy exposure from the phase 1/2 MajesTEC-1 trial (NCT03145181; NCT04557098). In this pivotal trial, the ORR with teclistamab was 63%, and the median PFS was 11.3 months.

Although these data affirm the efficacy of teclistamab across both clinical and real-world multiple myeloma settings, several unanswered questions remain regarding the optimal use of teclistamab in relapsed/refractory multiple myeloma, Grajales-Cruz begins. The current body of evidence in myeloma indicates that responses to CAR T-cell therapy are not always similar in patients who have received prior BCMA-directed therapy compared with those who have not, Grajales-Cruz explains. However, teclistamab has demonstrated benefit in populations of patients with multiple myeloma with prior exposure to BCMA-directed therapy, he notes.

Research efforts in multiple myeloma should therefore focus on elucidating the optimal sequencing of teclistamab with other novel agents, such as CAR T-cell therapies, elranatamab-bcmm (Elrexfio), and talquetamab (Talvey), Grajales-Cruz states, adding that investigations should place particular emphasis on patients who have received prior BCMA-directed therapy. Understanding how prior exposure to BCMA-directed therapy impacts responses to subsequent treatments and vice versa is essential for informing clinical decision-making and improving survival outcomes, Grajales-Cruz concludes.