Highlighting Bispecific Use Throughout A number of Myeloma Indications

In an interview with CancerCommunity®, Shebli Atrash, MD, medical oncologist at Levine Cancer Institute and medical affiliate professor of Medicine at Wake Forest University, mentioned his presentation on T-cell engagers in a number of myeloma that he gave on the 2025 Immune Cell Effector Therapy (ICE-T) Conference.¹

Initially, he specified that his presentation lined already authorised BCMA antibodies in addition to indications for sufferers who’re pan-refractory and immune to all accessible requirements for therapy. Contextualized by an estimated 70% general response price in trials evaluating BCMA antibodies in a number of myeloma, Atrash recommended that investigators had been evaluating this therapy in earlier strains of remedy.

Highlighting the part 3 MajesTEC-7 trial (NCT05552222), Atrash famous that researchers are evaluating teclistamab-cqyv (Tecvayli) towards the usual of care of daratumumab (Darzalex), lenalidomide (Revlimid), and dexamethasone—the MAIA trial (NCT02252172) routine—within the transplant-ineligible inhabitants.^2,3 Atrash additional defined that researchers have explored the addition of teclistamab to daratumumab/lenalidomide with or with out bortezomib (Velcade) for sufferers who’re eligible for transplant within the US. Additionally, he expressed that he has noticed deep responses following bispecific antibody use as induction remedy.

In the upkeep setting, Atrash famous that a number of trials are exploring bispecific use, together with the part 3 MajesTEC-4 trial (NCT05243797), which is evaluating teclistamab with lenalidomide vs lenalidomide alone.⁴ In the trial, Atrash defined that amongst these characterised as having minimal residual illness (MRD)–unfavorable standing at baseline, they maintained MRD negativity after the third cycle of therapy. He concluded by suggesting that use of MRD as an finish level must be carried out fastidiously, given doubtlessly fast recurrence amongst high-risk sufferers and illness development amongst those that are at a normal threat however have skilled gradual responses.

Transcript:

We mentioned bispecific antibodies for a number of myeloma. We went over the already authorised BCMA antibodies [and] the indication for sufferers who’re pan-refractory. [Trials evaluating BCMA antibodies] roughly confirmed us a 70% general response price with acceptable toxicity. The area is transferring in direction of earlier strains; bispecific antibodies are being examined for early relapse in addition to for newly recognized a number of myeloma. BCMA bispecific antibodies are [quite] efficient for newly recognized a number of myeloma, whether or not [patients] are transplant eligible or ineligible. Trials have been testing for transplant-ineligible [disease], using teclistamab in [the phase 3 MajesTEC-7 trial] towards customary of care, which is the MAIA protocol of daratumumab, lenalidomide, and dexamethasone.

For the US, we’re new to the trial. [Investigators have] been enrolling [outside of the] US for a while now, and the trial is opening quickly within the US. For transplant-eligible [disease], now we have integrated teclistamab enrichment with daratumumab/lenalidomide with or with out bortezomib. More fascinating to me is the idea of utilizing these bispecific antibodies as a single agent for induction. It is [quite] handy for sufferers as subcutaneous or [intravenous] administration, relying on the product. As a single agent, it appears to provide deep responses.

In the upkeep setting, there are just a few trials which might be that as nicely. We have the [phase 3 MajesTEC-4 trial] that checked out teclistamab with lenalidomide vs lenalidomide alone, which is our customary of care. The preliminary security run-in part enrolled few sufferers, however all sufferers who had been examined for MRD negativity had been MRD-negative after cycle 3. This is promising. If we consider that MRD negativity is the tip level to be, particularly for newly recognized and standard-risk sufferers, then these regimens are delivering what we ask for.

However, we should at all times watch out if you use MRD as an finish level as a result of sufferers with high-risk illness might relapse shortly, and sufferers with standard-risk illness and gradual response may additionally nonetheless present some [progression] that doesn’t replicate the danger evaluation for his or her illness.

References

1. Atrash S. Emerging T-cell engagers & novel immunotargets in a number of myeloma. Presented on the 2025 National Immune Cell Effector Therapy (ICE-T) Conference; July 26, 2025; Orlando, FL.
2. Krishnan AY, Manier S, Terpos E, et al. MajesTEC-7: A part 3, randomized examine of teclistamab + daratumumab + lenalidomide (Tec-DR) versus daratumumab + lenalidomide + dexamethasone (DRd) in sufferers with newly recognized a number of myeloma who’re both ineligible or not meant for autologous stem cell transplant. Blood. 2022;140(suppl 1):10148-10149. doi:10.1182/blood-2022-160173
3. Facon T, Kumar S, Plesner T, et al. Daratumumab plus lenalidomide and dexamethasone for untreated myeloma. N Engl J Med. 2019;380(22):2104-2115. doi:10.1056/NEJMoa1817249
4. Zamagni E, Boccadoro M, Spencer A, et al. MajesTEC-4 (EMN30): a part 3 trial of teclistamab + lenalidomide versus lenalidomide alone as upkeep remedy following autologous stem cell transplantation in sufferers with newly recognized a number of myeloma. Blood. 2022;140(suppl 1):7289-7291. doi:10.1182/blood-2022-159756