David R. Oveisi, MD, discusses the evolution and potential role of bispecific antibodies in multiple myeloma, and presents several areas of unmet need regarding their use in this space.
David R. Oveisi, MD, hematologist/oncologist, Cedars-Sinai Medical Center, discusses the evolution and potential role of bispecific antibodies in multiple myeloma, and presents several areas of unmet need regarding their use in this space.
Although the treatment landscape in multiple myeloma has greatly improved in recent years, patients who develop resistant disease still experience poorer outcomes. Bispecific antibodies provide new and promising treatment alternatives for these patients, with an abundance of promising agents coming through the pipeline, Oveisi begins.
Teclistamab-cqyv (Tecvayli) was the first BCMA-/CD3-targeted bispecific antibody to receive approval by the FDA in October 2022 for patients with relapsed/refractory multiple myeloma who received at least 4 previous lines of therapy, including a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody, Oveisi reports. The approval was based on findings from the phase 1/2 MajesTEC-1 trial (NCT03145181; NCT04557098), in which teclistamab produced an objective response rate of 61.8%, including a 28.2% complete response rate or better.
Alongside current research, this regulatory decision indicates the efficacy and potency of this class of BCMA-targeted agents in patients with heavily pretreated multiple myeloma, Oveisi says.
However, some patients who previously progressed on CAR T-cell therapy will also experience progression with teclistamab, creating a new unmet need for bispecific antibodies directed at targets other than BCMA, he notes.
Additionally, the role of bispecific antibodies within the current armamentarium is still being determined, although institutional experience has greatly helped efforts to understand optimal sequencing of agents in this space, Oveisi adds.
Lastly, there is significant interest in the long-term administration of bispecific antibodies, Oveisi states. Strategies to feasibly and safely do this without worsening common toxicities such as infection and mitigating risk are still in development, he explains. However, the ability to anticipate, and subsequently mitigate toxicity concerns associated with this drug class continue to improve, Oveisi concludes.