BCMA targeted immunotherapy for multiple myeloma
While the introduction of proteasome inhibitors, immunomodulators and monoclonal antibodies targeting CD38 have revolutionized the treatment of multiple myeloma, many patients become refractory to these agents. The B-cell maturation agent (BCMA) is expressed on 100% of plasma cells but not on immature hematopoietic cells or other normal tissue and has emerged as a novel target for immunotherapy in multiple myeloma. Agents targeting BCMA have been shown to significantly improve outcomes in triple-refractory patients. These agents include two CAR-T therapies, idecabtagene vicleucel (ide-cel) and ciltacabtagene autoleucel (cilta-cel), currently under regulatory review with the FDA for triple-refractory multiple myeloma and the antibody-drug conjugate belantamab mafodotin, approved in 2020 for patients who have received at least four prior therapies.
What factors will you consider when selecting a BCMA-directed therapy for triple-refractory patients? Are there certain groups of patients better suited for either an antibody-drug conjugate or a CAR-T therapy? Do you think anti-BCMA agents will eventually be used in earlier lines of therapy?