Nina Shah, MD
Recent dose-escalation findings in chimeric antigen receptor (CAR) T-cell therapy presented at the 2017 ASH Annual Meeting continue to show high potential in heavily pretreated patients with multiple myeloma.
on Hematologic Malignancies.
OncLive: You lectured on immunotherapy and novel agents for refractory myeloma. What developments have we been seeing?
: This is a really exciting field because there are multiple areas where there have been a lot of developments. We talked about the major categories of immunotherapy, including antibody therapy, cellular therapy, and some of the novel twists on antibodies, including antibody-drug conjugates, as well as bispecific antibodies. We talked about the updated elotuzumab (Empliciti) data, as well as that of daratumumab (Darzalex). Both of these have held onto their PFS benefit that they showed in the initial studies. That is exciting because a lot of patients are able to get these therapies sooner in their relapse course and for longer.
We talked about antibody-drug treatments. This includes antibody-drug conjugates, where a toxic drug is linked to an antibody so that the antibody delivers it specifically to the myeloma cell. We also discussed bispecific therapies; these are when antibodies are specific to myeloma cells, but they also have another part that is specific to a T cell. It brings the patients’ own T cells together with the antibody against the myeloma cell with hopes of killing the myeloma cell directly and having some T-cell membrane. That is one of the goals of that therapy.
2017 was an interesting year for checkpoint inhibitors in myeloma. Can you comment on the clinical trial holds?
A lot of us were very disappointed that the pembrolizumab (Keytruda) trials were halted in the initial phase II trials; there were 60% or 70% response rates, which is very hard to do in patients with myeloma. We know that checkpoint inhibitors probably need another drug to work. It is hard to have the single-agent activity and, therefore, it was just disappointing that we couldn’t pursue the phase III trial with immunomodulatory agents.
... to read the full story