New Immune Therapies for Myeloma Patients

Transcript: 

This week's "Ask Dr. Durie" comes from a patient who has been excited about all of the discussion of new immune therapies, but he has realized that there are different types, with different benefits and different side effects. And so, he has asked me to give a capsule summary of the pros and cons of the different types of new immune therapies. 

This is quite a difficult task to summarize. However, let me try my best to put this in capsule form. So broadly, there are three types of these new immune therapies. One is what's called a cellular type where you give cells, and the best example of this is the CAR T approach. There is an antibody-drug conjugate approach, and this is where a drug is attached to an antibody, it's a combination of an attack against the myeloma. And then there's a type that is called a bispecific antibody, where the antibody attaches to the myeloma but has a second - the bispecific - arm that attaches to the immune cells in the environment around the myeloma and brings together the immune cells to have a combined attack against the myeloma. 

So, what about the first type the cellular therapy, the CAR T cell approach? This is undoubtedly the most powerful of the three approaches. The T cells are harvested from the patient's bloodstream and then are engineered to attack the myeloma, right now targeting something on the surface of the myeloma called BCMA, B-cell maturation antigen. 

Two types of these CAR T cells have already been approved by the FDA and are available. And so, this is a very powerful approach. In the most recent trial, the CARTITUDE trial which was the basis for the second approval most recently for the Janssen company, 98% of the patients in these relapsed/refractory patients had a dramatic response to therapy. 

So, a large percentage of the patients have a dramatic benefit. This is what is called a one-time approach, where you harvest the cells, engineer them and give them to the patient, and then you have this dramatic benefit that is ongoing and the patients who respond are actually off therapy for a significant period of time. So, a lot of excitement about CAR T. The main drawback is that this is a specialized approach that for the time being will only be done at a more limited number of specialized centers across the country. 

So, what about the drug conjugate approach? This is, what was called the "Bela" compound and is available commercially and has been used for some time now. This is a very powerful therapy. It is, however, an ongoing therapy that is adjusted based on some of the side effects which include some effects on the eyes which is called keratopathy. So, in this case, dose adjustment/schedule adjustment is necessary related to this side effect. 

The third type, the bispecific antibody, is a very interesting and important approach, and there are many of these bispecifics in ongoing clinical trials. The farthest along is one called teclistamab, which is also targeted against BCMA. Results with this are very good, perhaps not quite as high of response rates as with CAR T cells, but excellent. 

The advantages are that it will be broadly available. We are expecting that, hopefully, this could be approved by the FDA maybe later this year. This would be an ongoing treatment and could be added in with other kinds of therapy. 

And so, this rapid overview allows you to see that this is a very exciting lineup. And so, BOTTOM LINE: These immune therapies provide a very bright future for new and better therapies for all myeloma patients.