My Treatment Approach Enhancing Treatment for Relapsed/Refractory Multiple Myeloma (RRMM): Converting Evidence to Effective Clinical Care - Episode 4
Discussing the Treatment Options for RRMM Following Progression After BCMA CAR T Therapy
Panelists discuss how various treatment options, including selinexor-based regimens, B-cell maturation antigen (BCMA)–targeted therapies, bispecific antibodies, and CELMoDs, can be used to manage relapsed/refractory multiple myeloma following progression on BCMA-directed chimeric antigen receptor T-cell therapy (CAR T).
Physician Summary: Treatment Options After Progression Following BCMA-Directed CAR T Therapy
After progression on BCMA-directed CAR T therapy, several treatment options have demonstrated efficacy in relapsed/refractory myeloma:
- Selinexor-based regimens: Effective in CAR T–refractory myeloma (BOSTON trial data). Selinexor can help control disease and may enhance subsequent CAR T efficacy.
- BCMA-targeted therapies:
- Teclistamab, elranatamab, and belantamab mafodotin (immune-engager therapies) have shown promise as next-line therapies following BCMA-directed CAR T relapse.
- Talquetamab: A GPRC5D-targeted bispecific antibody that has shown potential in patients with relapsed BCMA-directed CAR T therapy.
- Cytotoxic chemotherapy: Can be considered for aggressive disease or as a bridge while awaiting other treatments but carries the risk of T-cell suppression.
- CELMoDs: Novel immunomodulatory drugs (IMiDs) may enhance CAR T functionality and could offer benefit in post-CAR T relapse settings.
Key Takeaway: Post-BCMA CAR T progression requires careful consideration of available therapies like bispecific antibodies, selinexor, and novel CELMoDs to manage disease and potentially enhance response to future treatments.