Dr Ignatz-Hoover on Bispecific Antibodies in the Multiple Myeloma Treatment Armamentarium

James Ignatz-Hoover, MD, PhD, hematologist/oncologist, University Hospitals Seidman Cancer Center, discusses the current arsenal of FDA-approved bispecific antibodies in multiple myeloma, and expands on challenges that arise when selecting between these agents.

The multiple myeloma treatment landscape has expanded significantly with the FDA approvals of the bispecific antibodies teclistamab-cqyv (Tecvayli), elranatamab-bcmm (Elrexfio), and talquetamab-tgvs (Talvey), Ignatz-Hoover begins. The first 2 B-cell maturation agents target BCMA, while talquetamab targets GPRC5D. These approvals have provided additional options for patients who have received at least 4 prior lines of therapy and are triple-class exposed, having been treated with a proteasome inhibitor, a CD38 inhibitor, and an immunomodulatory agent (iMID), he details.

All 3 agents have received accelerated approvals, have the same FDA indication, and have similar efficacy and safety profiles, Ignatz-Hoover states. Moreover, these agents all produce overall response rates of approximately 60%, with a significant proportion of patients achieving very good partial response or better, he says. Median progression-free survival rates are also comparable across the agents. However, due to the lack of head-to-head comparisons, it is challenging to determine which agent is superior in terms of efficacy, Ignatz-Hoover notes.

Differences in adverse effect (AE) profiles exist among the agents, with talquetamab potentially causing hair, nail, and oral-pharyngeal AEs that are not observed with teclistamab, Ignatz-Hoover continues. Teclistamab may carry a slightly higher risk of infections compared to talquetamab, although both agents are associated with infection risks, he adds.

Selecting the optimal sequencing of these BCMA-targeting agents has become a critical consideration in myeloma treatment, Ignatz-Hoover says. As all 3 agents have received similar FDA indications, treatment decisions may initially be influenced by local practice patterns until more data become available to guide their use in different treatment settings, Ignatz-Hoover concludes. Ongoing research is needed to elucidate the optimal sequencing and long-term efficacy and safety profiles of these agents.