BiTEs and ADCs in RRMM: Long-Term Efficacy “Yet to Be Established”

Bispecific T-cell engagers (BiTEs) and antibody-drug conjugates (ADCs) “appear to have tolerable safety and reasonable efficacy profiles” in the treatment of relapsed or refractory multiple myeloma (RRMM), but have yet to establish long-term efficacy, conclude the authors of a systematic review of prospective studies of these agents, which was published online in Annals of Hematology in July.

Because these agents are available off the shelf and can be administered relatively safely, “they may be useful as salvage therapy for patients with aggressive relapsed disease who cannot wait 4–6 weeks to receive CAR T-cell infusion,” write Faiz Anwer, MD, of the Cleveland Clinic Lerner College of Medicine and an international group of co-authors. However, unanswered questions about these agents include the appropriate timing and sequencing of their use and the appropriate duration of therapy in patients who achieve at least a partial response.

The analysis included 13 prospective studies, of which 10 were phase 1 and 3 were phase 2; 168 patients were enrolled in studies of BiTEs and 428 in studies of ADCs. Patients ranged in age from 24 to 82 and had received from 2 to 21 prior lines of therapy. Due to variability in dose, frequency, patient selection criteria, and drug target in individual trials, the authors concluded that the trial results cannot be generalized.

“Future studies with newer combinations and a longer follow-up are needed to determine the precise role of these novel therapies in the evolving paradigm of MM treatment,” the authors write.

  • Khattak ZE, Hashmi H, Khan SI, et al. Dawn of a new era of antibody-drug conjugates and bispecific T-cell engagers for treatment of multiple myeloma: a systematic review of literature. Ann Hematol. 2021;100(9):2155-2172. doi:10.1007/s00277-021-04599-5

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