How it is administered

Elranatamab is given as a subcutaneous injection, which means it is injected under the skin. It is supplied as a ready-to-use liquid solution in single-dose vials (either 44 mg/1.1 mL or 76 mg/1.9 mL). The initial dosing involves a 'step-up' schedule to help reduce the risk of certain side effects, followed by regular maintenance doses:

• Day 1: 12 mg (step-up dose 1)
• Day 4: 32 mg (step-up dose 2)
• Day 8: 76 mg (first full dose)
• Then: 76 mg weekly through week 24
• If you respond and maintain a response, dosing may change to every 2 weeks (from week 25 onward), and potentially every 4 weeks after week 49.

Elranatamab should only be administered by a healthcare professional in a medical setting, especially for the first doses, as close monitoring is required.

How it works

Elranatamab is a type of immunotherapy called a bispecific antibody. It is designed to help your immune system recognize and attack multiple myeloma cells. Specifically, elranatamab binds to two different proteins:

• BCMA (B-cell maturation antigen), which is found on the surface of multiple myeloma cells
• CD3, which is found on T-cells (a type of immune cell)

By binding to both BCMA and CD3, elranatamab brings T-cells into close contact with the myeloma cells. This activates the T-cells, causing them to attack and destroy the cancer cells. This process also leads to the release of substances called cytokines, which help coordinate the immune response but can also cause side effects.

Elranatamab is used when multiple myeloma has returned or has not responded to several other treatments. It offers a new way to target cancer cells by harnessing the body's own immune system.

Who Should take it

Elranatamab is indicated for adults with relapsed or refractory multiple myeloma who have received at least four prior lines of therapy. These previous treatments must have included:

• A proteasome inhibitor
• An immunomodulatory agent
• An anti-CD38 monoclonal antibody

This means elranatamab is typically used when other standard treatments have stopped working or the disease has come back. It is not used as a first-line therapy, but rather as an option for patients who have limited alternatives due to resistance or relapse after multiple prior treatments.

Who should not take it

There are no absolute contraindications listed for elranatamab. However, it should not be started in patients who have active infections. Caution is needed in patients with a history of severe reactions to similar therapies or those with significant liver or kidney problems, as safety in these groups is not fully established.

Women who are pregnant or may become pregnant should not take elranatamab, as it may cause harm to an unborn baby. Women should use effective contraception during treatment and for at least 4 months after the last dose. Breastfeeding is also not recommended during treatment and for 4 months after the last dose.

Commonly used with

Elranatamab is used as a single agent (monotherapy) for relapsed or refractory multiple myeloma. It is not typically combined with other anti-myeloma drugs, especially at the start of treatment, due to the risk of overlapping side effects and the need for close monitoring.

Commonly tested with

In clinical trials, elranatamab has been studied mainly as a single agent in patients who have already received multiple other therapies for multiple myeloma. It has not been routinely tested in combination with other anti-myeloma drugs in the pivotal studies, but future research may explore combinations.