Optimizing Sequencing of BCMA-Directed Therapies in Myeloma

A retrospective analysis presented at the American Society of Hematology annual meeting looked at multiple myeloma patients’ responses to teclistamab (Tecvayli), including among those previously treated with other B-cell maturation antigen (BCMA)-directed therapies.

In this exclusive MedPage Today video, Jack Khouri, MD, of the Cleveland Clinic Taussig Cancer Institute, shares insights on sequencing BCMA-targeted therapies, including a practical tip to potentially enhance patient outcomes with teclistamab.

Following is a transcript of his remarks:

We’ve been very lucky in myeloma to have many really effective agents targeting BCMA on the plasma cells. And we’re still trying to figure out how to sequence those treatments for our patients to optimize the responses.

So we looked at patients who received teclistamab, which is a bispecific targeting BCMA, and these are patients that actually had received, before teclistamab, other BCMA-directed therapies. And then they were treated with teclistamab. Some of these BCMA-directed therapies include CAR T-cell therapy, other bispecific antibodies, and antibody-drug conjugates.

And then we looked at how these patients responded to teclistamab. What we found was a lower overall response rate with teclistamab if they had received prior BCMA-directed therapy. So that’s a 51% overall response rate versus a ~61% response rate for BCMA-naive patients. So that’s a lower response rate. And then there was a trend towards an inferior progression-free survival compared to patients who are BCMA-naive. So all in all, lower responses and potentially lower PFS, progression-free survival.

And then we kind of looked at the gap of time or the time off of BCMA therapy for patients who actually responded better. So patients who had a time gap of at least 9 months between whatever BCMA-directed therapy they had and teclistamab, those are the patients that actually had the best responses.

So I think this is a really helpful, kind of practical tip. If docs or practitioners are thinking about using or sequencing different BCMA-directive therapies, I think allowing that time gap between those treatments actually may get better responses for the patients.

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