Bispecific monoclonal antibody improves remission rate in patients with myeloma

This article is from NEJM Journal Watch A Novel Immunotherapy for Relapsed or Refractory Myeloma.
Commentary Author: Michael E.
Williams, MD, ScM Targeting the Myeloma Cell Proteins BCMA and T The bispecific monoclonal antibody to the cell helper receptor CD3 is effective in patients who have received a lot of treatment in the past
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Bispecific antibodies can bind to tumor cell surface antigens and T cell CD3 at the same time, so that tumor cells and effector cells are juxtaposed, thereby exerting anti-tumor activity on recurrent B-cell malignancies
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In an industry-funded phase 1, multicenter trial, researchers evaluated intravenous or subcutaneously administered teclistamab (targeting B cell maturation antigen [BCMA] and CD3) in patients with relapsed or refractory multiple myeloma.
Bispecific antibody) monotherapy
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The purpose of the study is to determine the safety and tolerability of the drug, and to determine the recommended dose (RP2D) for the phase 2 trial
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Treatment continues until the disease progresses or unacceptable toxicity occurs
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The 157 patients included in this trial have received a large number of treatments in the past, and the median number of treatment lines in the past was 6
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After completing the initial dose escalation period, 40 patients received subcutaneous administration of RP2D at 1,500 µg/kg weekly
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Of these 40 patients, 37% had high-risk cytogenetic characteristics, and 85% had received stem cell transplantation
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No dose-limiting toxicity was observed under RP2D; the incidence of cytokine release syndrome was 70% (all grades 1 to 2), and the incidence of grade 3 to 4 neutropenia was 40%
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23% of patients achieved complete remission, and 58% of patients achieved very good partial remission or better efficacy, and the remission rate increased over time
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Comment This study proves the efficacy of a new type of bispecific immunotherapy drug for myeloma patients who have received a lot of treatment in the past
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Other bispecific antibodies for the treatment of myeloma and various lymphomas are under development
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The mechanism of action of these drugs is similar to that of chimeric antigen receptor T cells (CAR-T)
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Further research and development of these drugs is of great significance to patients who have received standard immunotherapy, targeted therapy, high-dose chemotherapy, and autologous stem cell transplantation
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The reviewed article Usmani SZ et al.
Teclistamab, a B-cell maturation antigen × CD3 bispecific antibody, in patients with relapsed or refractory multiple myeloma (MajesTEC-1): A multicentre, open-label, single-arm, phase 1 study.
Lancet 2021 Aug 21; 398:665.
(https://doi.
org/10.
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