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New treatments for multiple myeloma are a popular topic of conversation among members of MyMyelomaTeam. Many discuss BCMA-targeted therapy, a promising new type of treatment for RRMM.
One member who had just begun taking a BCMA-targeted therapy wrote, “The drug isn’t chemo. It teaches your immune system to attack the BCMA receptor on the cancer cells and kill them.” Another responded, “Thanks for sharing this information. I’m going to speak to my oncologist about it.”
Learning all you can about new therapies is key to having good conversations with your doctor about treatment options. Perhaps you’ve already heard of anti-BCMA therapy, or maybe this type of treatment is new to you. Either way, keep reading to learn more details about BCMA-targeted drugs.
In multiple myeloma, plasma cells develop genetic changes that cause them to become cancerous. B-cell maturation antigen is a protein found on nearly all multiple myeloma cells — and isn’t usually found on any healthy cells aside from plasma cells. Because BCMA is on myeloma cells but not regular cells, it’s an effective target for treating multiple myeloma.
Anti-BCMA treatments are a type of immunotherapy. Immunotherapy is a treatment approach that uses your immune system to fight disease. Anti-BCMA is a targeted treatment that focuses mainly on destroying cancer cells, leaving most healthy cells intact. This makes anti-BCMA therapy a very different approach from other myeloma treatments like chemotherapy, radiation, bone marrow transplants, and surgery.
BCMA-targeted therapies are approved for adults living with relapsed/refractory multiple myeloma. Relapsed myeloma happens when myeloma treatments work at first, but then the blood cancer returns. Refractory multiple myeloma happens when the blood cancer does not respond to treatment at all.
Doctors will recommend anti-BCMA therapies only if you’ve had at least four treatment regimens, with at least three types of drugs. These might include:
Read more about treatment options for relapsed myeloma.
BCMA-targeted therapies are a new modality, or type of treatment, for myeloma. As of August 2023, four anti-BCMA therapies have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of multiple myeloma. These are:
Although these are all anti-BCMA therapies, each targets BCMA in a slightly different way. Teclistamab-cqyv and elranatamab-bcmm are bispecific T-cell engagers, or BiTEs. Idecabtagene vicleucel and ciltacabtagene autoleucel are chimeric antigen receptor T-cell (CAR T-cell) therapies.
Idecabtagene vicleucel, sold under the brand name Abecma, is a CAR T-cell therapy. CAR T-cell therapy works by modifying your T cells. To treat multiple myeloma, your T cells are altered so they identify, target, and attack BCMA on myeloma cells. CAR T-cell therapies are developed specifically for a single person and given in one infusion.
The FDA approved Abecma for RRMM in March 2021 based on results in clinical trials. In these trials, the overall response rate (the number of people whose blood cancer went away or got partially better) for Abecma was 72 percent. The complete response rate (the number of people whose blood cancer was undetectable on tests after treatment) was 28 percent. Among those who had a complete response, 65 percent had their response last for at least a year before myeloma appeared again. (This measure is known as the duration of response.)
Ciltacabtagene autoleucel, sold under the brand name Carvykti, is another type of CAR T-cell therapy. Carvykti was approved by the FDA to treat RRMM in February 2022.
Like Abecma, Carvykti is a CAR-T cell therapy given as a single infusion, but they have differences. Abecma binds to BCMA in one place, whereas Carvykti binds to BCMA in two places.
Carvykti was approved based on the overall response rate and the duration of response in clinical trials. Carvykti’s overall response rate was 98 percent. Its median duration of response was 22 months. This means that, for half of the people in the trials, treatment results lasted longer than 22 months, and the other half saw their myeloma begin to return in less than 22 months.
Although anti-BCMA CAR T-cell therapies are approved for people living with RRMM, they can be difficult to get. They require time to be developed for each person, so they may not be the best option if you need treatment immediately.
Bispecific T-cell engagers are another new treatment for RRMM. BiTEs use monoclonal antibodies, laboratory-made proteins that work like natural human antibodies. Antibodies help your body recognize and remove unhealthy bacteria, viruses, and cancerous cells.
BiTEs like teclistamab-cqyv fight myeloma by binding in two ways. First, the bispecific antibody binds to BCMA on the myeloma cell. The anti-BCMA antibody also binds to a nearby T cell. After the antibody binds to both of these cells, the T cell’s cytotoxic (cell-killing) ability is activated. The T cell releases material that kills the myeloma cell.
In October 2022, teclistamab-cqyv (sold under the brand name Tecvayli) became the first FDA-approved BCMA bispecific antibody for the treatment of multiple myeloma. Tecvayli was approved based on the overall response rate in clinical trials. The overall response rate for this bispecific antibody was 62 percent. It’s given subcutaneously (under the skin).
Elranatamab-bcmm, sold under the brand name Elrexfio, is a BCMA bispecific antibody approved by the FDA in August 2023. In clinical trials, the overall response rate of Elrexfio for the treatment of multiple myeloma was 58 percent.
Elrexfio is given under the skin. It also works by binding to BCMA on myeloma tumor cells and T cells, causing myeloma cell death.
Treatment with BCMA bispecific antibodies is easier to access than the CAR T-cell therapies because they don’t have to be manufactured specifically for each person. Bispecific antibody treatments are “off the shelf” and available right away.
The newest BCMA-targeted multiple myeloma drug, P-BCMA-ALLO1, is being developed by Poseida Therapeutics. The company was granted an orphan drug designation by the FDA in March 2024 for the treatment of multiple myeloma in adults whose myeloma has relapsed or hasn’t responded to prior treatment. Early data from the first phase of clinical trials in 2023 suggests that this BCMA-targeted CAR-T cell therapy is likely safe and effective. The CAR-T cells travel to the bone marrow and last for at least six weeks after treatment, remaining in cancerous sites and fighting cancer cells.
According to study findings presented at the 2023 American Society of Hematology Annual Meeting, 82 percent of people who received this treatment had an objective response to the medication.
Like all medications, even those sold over the counter, anti-BCMA therapies have potential side effects or toxicities. Not every person will experience every side effect. Your doctor knows the details of your condition and can advise you about your risk for different side effects.
All four BCMA-targeted therapies for RRMM share some common side effects:
The FDA prescribing information lists rare but serious side effects of Abecma for the treatment of multiple myeloma, including:
Rare but serious side effects of Carvykti for the treatment of multiple myeloma include:
Rare but serious side effects specific to Tecvayli for the treatment of multiple myeloma include:
Rare but serious side effects of Elrexfio for the treatment of multiple myeloma include:
If you or your loved one with myeloma has already tried four treatments for multiple myeloma that haven’t worked, or if your myeloma has relapsed after four or more lines of therapy, you may qualify for BCMA-targeted immunotherapy. If you’d like to learn more about anti-BCMA treatments, ask your myeloma specialist if they might be safe and effective for you.
Read more about life expectancy with relapsed/refractory myeloma.
MyMyelomaTeam is the social network for people with multiple myeloma and their loved ones. On MyMyelomaTeam, more than 25,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple myeloma.
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Leonora Valdez Rojas, M.D.
received her medical degree from the Autonomous University of Guadalajara before pursuing a fellowship in internal medicine and subsequently in medical oncology at the National Cancer Institute.
Learn more about her here.
Christina Nelson, M.D.
earned a Doctor of Medicine from the Frank H. Netter, MD School of Medicine at Quinnipiac University in 2023.
Learn more about her here.
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I have taken tecvali for 5 months and I am in remission
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