BCMA-Targeted Bispecific Antibodies Are ‘Encouraging’ for Some With Myeloma

Bispecific antibodies may be promising for patients who cannot tolerate CAR T-cell therapy.

BCMA-targeted treatments—such as bispecific antibodies and CAR T-cell therapies—represent a promising new wave of treatment for patients with multiple myeloma, as they specifically target the BCMA protein found on cancer cells. In a Community Case Forum event, advanced practice providers discussed their experience in treating patients with bispecific antibodies.

“We know that patients who have elevated BCMA levels have worse outcomes, and we also know that it's thought that upregulated expression during myeloma pathogenesis leads part of the transition from MGUS [monoclonal gammopathy of undetermined significance] to smoldering myeloma and then to active disease,” event moderator, Tiffany Richards, PhD, ANP-BC, said during the event. Richards is a nurse practitioner in the Lymphoma and Myeloma Program at The University of Texas MD Anderson Cancer Center in Houston.

Bispecific Antibodies a ‘Promising Alternative’

There are currently 3 FDA-approved bispecific antibodies in the relapsed/refractory multiple myeloma space: teclistamab (Tecvayli), elranatamab (Elrexfio), and talquetamab-tgvs (Talvey). Each of these drugs are for patients who have received 4 or more prior lines of therapy.

One event attendee noted that bispecific antibodies offer a reasonable option for patients who may not be able to tolerate CAR T-cell therapy. This type of treatment, while oftentimes effective, can come with severe side effects and longer hospital stays.

“There’s a place for bispecific [antibodies] in the treatment landscape for many of our older patients who are not CAR-T eligible. They have been able to participate [in bispecific antibody treatment] and gain deeper response,” the attendee said. “These regimens are not particularly cumbersome [to administer]. Teclistamab is subcutaneous. We’ve had some [intravenous administration], but for the most part, what we’ve given and what I’ve seen is that there have been some pretty deep responses with minimal side effects. And that’s encouraging, because some of the CAR [T-cell therapy] side effects can be devastating.”

READ MORE: AE Profile of Bispecific Antibodies Can Be Predictable in Myeloma Management

Efficacy of Bispecific Antibodies

In conjunction with its real-world efficacy, Richards also presented data from clinical trials that support bispecific antibody use.

For example, the MonumenTAL-1 trial (NCT03399799) of talquetamab showed that the objective response rate (ORR) for patients whose myeloma progressed on prior therapies was 74.1% and 69.5% in the 0.4 mg/kg QW and 0.8 mg/kg Q2W groups, respectively. This included very good partial responses (59.4% and 59.1%) and complete responses (CR; 32.9% and 40.3%).

Long-term data from the MajesTEC-1 trial (NCT04557098) showed that for patients treated with teclistamab, the median duration of response (DOR) was 24 months (95% CI, 17.0-NE), while median progression-free survival (PFS) was 11.4 months (95% CI, 8.8-16.4) and median overall survival (OS) was 22 months (95% CI, 15.1-29.9). The ORR in this study population was 63%, including 46.1% of patients that had a CR or better.

The MagnetisMM-3 trial (NCT04649359) investigated elranatamab in relapsed/refractory myeloma. Data from this trial showed a 61% ORR, with 35% of patients who experienced a CR or better. At a median follow-up of 14.7 months, median DOR, PFS, and OS had not yet been reached.

Returning Patients to the Community Setting

Many patients may be treated with a bispecific antibodies in an academic setting and then return back to a community oncologist. Advanced practice providers are key in keeping patients and their clinical teams informed.

“I will usually call [the community setting] myself and give a handoff,” Richards said.

Another participant discussed the importance of thorough documentation and ensuring that patients can handle other health complications as well.

“We send and chart everything,” the participant said. “I want to make sure that patients are taking care of their chronic disease management too. I know they're focused on [the] cancer part, but we want to make sure that the kidneys are still working good, liver, that they're taking their medicines, because sometimes patients will say they feel like they are lost in the sauce, as I say, because they are seeing the specialist so much they forget about the other primary care [provders]. And so I remind them.”