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MAJESTIC-1 Study - A Subgroup Analysis of High-risk Patients | Luciano Costa, MD | EHA2024
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• June 24, 2024
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So here at EHUB 2024, having the pleasure to present some data on some subgroup analysis of the Majestic 1 trial. So just to refresh your memory, Majestic 1 was a single arm dose finding study for teclistomab, which is really the study that provides evidence that led to the approval of teclistomab in the US and other jurisdictions. And of course there's some interest in seeing how that therapy performs in different subgroups of patients, particularly patients with features that we all understand are high risk of disease, you know, cytogenetic high risk, extramedular disease, high beta-2 microglobulins and so forth. The good news is overall this treatment performs well. The response rate for the overall study is close to 65%. And that is maintained in several important subgroups of patients, for example patients with high cytogenetic risk and patients with a relatively high proportion of plasma cells in the bone marrow. We're starting to see less response on patients with revised, you know, the ISS3, so those patients with very high beta-2 microglobulin, and particularly on those patients with extramedular disease, where the response is about half of what we would see on patients without extramedular disease, which are pockets of myeloma in places other than the bone marrow, for example in the lymph nodes or in the liver and some other places. So I think it is give us some guidance as we counsel patients on the best choice of the therapy that's right for them. Give us some reassurance for some of those subsets where we know this drug performs well. And show us the opportunity for improvement, you know, perhaps with combinations with an immunomodulatory agent, perhaps with a cell mod, or perhaps even with another by specific We saw recently on the redirect trial where a very high rate of response was achieved with extramedular disease when you combine Teclistamab and Toquetamab, for example.

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