BCMA-Directed Agents for Multiple Myeloma
Nina Shah, MD, on BCMA-directed treatments for patients with multiple myeloma.
Nina Shah, MD: The BCMA [B-cell maturation antigen]–directed agents are generally FDA approved in later lines. For belantamab mafodotin [Blenrep], it’s after 4 treatments. For the CAR T-cell therapy [idecabtagene vicleucel], it’s after 4 lines. [Approvals contain] similar verbiage but [there are] subtle differences. We usually see these therapies being chosen in the late line. The issue is that not all BCMA[-directed] therapies are the correct match for all patients. For example, if you’re going to get a CAR T-cell therapy, it does require a lot of timing and coordination for which the patient has to be ready to come to a specialized center. For apheresis, [the patient] has to have a caregiver and has a plan that’s complicated, albeit a short plan because it’s a 2-month commitment to the specialized center. On the flip side, having a BCMA-directed antibody-drug conjugate is something that a patient can get off the shelf and can get in his or her community setting. It does require having an eyecare professional or eyecare specialist alongside to be able to manage and measure for keratopathy. These are all things you can do as an outpatient, and some people find that to be a very friendly regimen because they don’t have to go to a specialized center. The BCMA bispecifics will then be a hybrid because the first 1 or 2 doses may require being hospitalized or going to a specialized center that is used to dealing with CRS [cytokine release syndrome], or potentially neurotoxicity. Then after the first 1 or 2 doses, the patients will be able to get that therapy at home. Based on that, it will allow more patients to get that therapy and have it more available. Maybe they’re willing to pay in for the first week or 2 of therapy at a specialized center, but they won’t have to do that for long term. All of these therapies are very patient friendly after you get through the logistics, and I’ve been very impressed with how tolerable they are once you know how to manage the toxicities.
