ASCO 2023: Using Elranatamab for Myeloma Patients Previously Treated with BCMA-Directed Therapy

The drug space for relapsed/refractory myeloma is exploding with options. The growth in this field within the last five years is ground-breaking, and things only continue to improve. Because myeloma is such a unique disease, having many options for patients whose disease differs is vital in finding a cure for all. 

One of the newer therapies for relapsed/refractory myeloma patients is elranatamab, a bi-specific antibody targeting BCMA on the myeloma cell. As you may know, it's not the only immunotherapy in the market right now that targets BCMA.

With other similarly targeted bi-specifics and CAR T Therapy, it's vital to understand the most efficient sequencing of these similar treatments without eliminating t-cell vitality. 

Recently, at the 2023 ASCO Conference, Dr. Ajay K. Nooka presented a pooled analysis from the many MagnestisMM studies regarding elranatamab to share the efficacy and safety of the drug for patients with relapsed/refractory multiple myeloma, specifically, those patients who already received BCMA-directed therapy through CAR T therapy or bi-specific antibody treatments. 

What questions were they trying to answer?

What is the efficacy and safety of elranatamab in patients with relapsed/refractory multiple myeloma and prior exposure to BCMA-directed therapy?

How many people participated, what were the qualifications?

In total, 86 pts were included. The median age was 66. 

Other qualifications include diagnosis of multiple myeloma with measurable disease, refractory to at least one immunomodulatory drug, a proteasome inhibitor, and one anti-CD38 antibody, relapsed/refractory to last myeloma treatment, and cohort A (one of the trial arms) should not have received prior BCMA-directed therapy while cohort B (the other trial arm) has received prior BCMA-directed therapy. 

How long did the study last and when was it completed?

The study had a median follow-up of 10.3 months. Although this was a combination of trials that were presented, they began in 2021 and should end around early 2024. 

What were the final results?

Elranatamab was efficacious and well tolerated; the median progression-free survival was 4.8 months, the duration of response was at nine months and the median overall survival had not been reached at 10 months.

The most common adverse effects of treatment were anemia, neutropenia, thrombocytopenia, diarrhea and lymphopenia. The toxicities were manageable and no significant safety concerns were reported in those who had not received BCMA-directed therapy previously. 

Among those with prior BCMA CAR-T treatment, the overall response rate (ORR) was 52.8%; the median progression-free survival was 10 months, and the median duration of response was not reached.  

Why is this important to patients in today’s myeloma?

Elranatamab was proved to be effective and safe as a monotherapy in patients with relapsed and refractory multiple myeloma, even in those who had previously received BCMA-targeting therapies. 

Also, because elranatamab is a monotherapy, the patient only has to take one medication, reducing the risk of adverse events and improving quality of life. 

The results support elranatamab monotherapy as a treatment option with relapsed/refractory myeloma post-BCMA-directed therapy. Although it's not currently FDA- approved for clinical use in the United States, it's definitely a drug to keep our eyes on! 

We would like to thank the following physicians and organizations for making this trial possible, along with the patients and caregivers who participated. 

Ajay K. Nooka, Alexander M. Lesokhin, Mohamad Mohty, Ruben Niesvizky, Christopher Maisel, Bertrand Arnulf, Sarah Marie Larson, Asya Varshavsky Yanovsky, Xavier P Leleu, Lionel Karlin, David H. Vesole, Nizar J. Bahlis, Carlos Fernández de Larrea, Noopur S. Raje, Eric Leip, Umberto Conte, Mohamed Elmeliegy, Andrea Viqueira, Salomon Manier

Organizations: Winship Cancer Institute, Emory University Hospital, Atlanta, GA, Division of Hematology and Oncology, Memorial Sloan Kettering Cancer Center/Weill Cornell Medical College, New York, NY, Sorbonne University, Hôpital Saint-Antoine, and INSERM UMRs938, Paris, France, Weill Cornell Medical College - New York Presbyterian Hospital, New York, NY, Baylor University Medical Center, Dallas, TX, Hôpital Saint-Louis, Paris, France, University of California Los Angeles Medical Center, Los Angeles, CA, Fox Chase Cancer Center, Philadelphia, PA, Centre Hospitalier Universitaire de Poitiers, Poitiers, France, Centre Hospitalier Lyon Sud, Lyon, France, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, AB, Canada, Hospital Clínic de Barcelona, Barcelona, Spain, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, Pfizer Inc., Cambridge, MA, Pfizer Inc., New York, NY, Pfizer Inc., San Diego, CA, Pfizer SLU, Madrid, Spain, Lille University Hospital, Lille, France