Dr Cohen on Efforts Needed to Unmet Needs in R/R Multiple Myeloma

Adam D. Cohen, MD, director, Myeloma Immunotherapy, associate professor in medicine, hematology/oncology, Abramson Cancer Center, University of Pennsylvania, discusses unmet needs and areas for future investigation within the relapsed/refractory multiple myeloma treatment landscape.

The armamentarium for this population has greatly expanded in recent years with the addition of several BCMA-directed CAR T-cell therapies and bispecific antibodies. In 2021, the CAR T-cell therapies idecabtagene vicleucel (ide-cel; Abecma) and ciltacabtagene autoleucel (cilta-cel;Carvykti) both gained FDA approval for patients with relapsed or refractory disease who have progressed on 4 or more previous lines of therapy. The regulatory decisions were based on findings from the phase 2 KarMMa trial (NCT03361748) and the phase 1b/2 CARTITUDE-1 trial (NCT03548207), respectively. The bispecific antibody teclistamab-cqyv (Tecvayli) also gained approval for this population in 2022 based on data from the phase 1/2 MajesTEC-1 trial (NCT03145181; NCT04557098).

BCMA-targeted agents are highly potent and produce deep and durable responses in triple- or penta-refractory patients, Cohen begins. Although their use has significantly improved treatment outcomes, these agents are not curative for the majority of patients, Cohen states. Therefore, it is important to better understand the optimal role and sequencing of BCMA-targeted immunotherapies in this field, he says.

Additionally, there are still patient subsets that do not respond well to current CAR T-cell therapies or bispecific antibodies, Cohen adds. This can include patients with extramedullary disease or those who have high-risk cytogenetics, he adds. Clinical trials that are done in multiple myeloma often exclude patients with higher-risk features such as renal failure, plasma cell leukemia, amyloidosis, or central nervous system involvement, Cohen notes.

It is important to understand the efficacy and safety of these agents in these difficult-to-treat populations, as patients with these conditions commonly seek treatment for their disease in the real-world setting, Cohen states. To this end, research efforts should focus on collecting more data on the use of BCMA-targeted therapies in these underrepresented groups, Cohen concludes.

Disclosures: Dr. Cohen reports serving as a consultant or in an advisory role for Celgene, BMS, Takeda, Janssen, Seattle Genetics, AstraZeneca, Genentech/Roche, Oncopeptides, GlaxoSmithKline, Arcellx, Ichnos; he received research funding from Novartis, GlaxoSmithKline; he has intellectual property licensed by institution to Novarti.