A Second View: Discussing BCMA targeted therapies in r/r multiple myelomaTicker(s): BMY, GSK, TSVT, LEGN, JNJ
Institution: Washington University St. Louis
- Professor Department of Medicine Oncology Division Bone Marrow Transplantation & Leukemia.
- Principal investigator on several national clinical trials looking at strategies to improve the outcome of patients with multiple myeloma, acute myeloid leukemia, and myelodysplastic syndromes.
- Currently treats ~300 patients with multiple myeloma (total), 10 patients with CMML, and ~15 patients per month with AL Amyloidosis.
Can you give an overview of your practice and research interests as they related to Multiple Myeloma?
Can you go over what the current SOC for MM is for the 1st, 2nd and 3rd line? I know there are a lot of options like immunomodulatory agents, anti-CD38s, and proteasome inhibitors, so I was kinda hoping you could simplify it for anyone listening on this call
Can you give a brief overview about your experiences with Blenrep and Ide-cel and your overall opinions of them? And your opinion of teclistamab?Added By: c_admin
So the main issue I hear about Blenrep is the very high incidence of ocular toxicity, which is obviously pretty troubling, I was hoping you could give me a scenario where you would use Blenrep in 4L+ MM vs other options, including ide-cel.
Can you discuss your experience dealing with the AE profile of Ide-cel? In particular, CRS, hematological AEs and neurotoxicities?Added By: c_admin
So concerning ide-cel, in the third quarter of 2021, it already has over double the sales of Blenrep despite it being the first full quarter. I guess my first question is, do you find that surprising? And my next question is, based on your experiences, can you provide commentary on any issues regarding the reimbursement or manufacturing for ide-cel?Added By: c_admin
Are you familiar with cilta-cel from legend biotech? In the Cartitude-1 trial, they showed a 97.9% ORR, with 80.4% having a sCR. Median duration of response of 21.8 months across all patients. Which is really stunning and compares very favorably against ide-cel. I’m going to assume cilta-cel is approved in February. If you were to guess, how do you think it will play out commercially? Do you think prescribers will rush to use cilta-cel over ide-cel, or do you think this will be more like the CD19 CAR-Ts where the market both Kymriah and Yescarta both still see use in NHL?Added By: c_admin
From your PoV, do you see any real utility in more BCMA CAR-Ts given that they should all be pretty similar wrt efficacy and safety? I think there’s over 10 in development not including the two I already mentioned.Added By: c_admin
Can you give your thoughts about moving these therapies into earlier lines and any challenges you foresee with that?Added By: c_admin
so for the BCMA Bites, I noticed Teclistamab was filed a few days ago. It’s my understanding that theoretically they would be best for patients who have received fewer prior lines of therapy due to the reliance on the cytotoxic potential of the T cells . Can you talk about where you think they will be in the market, given that they should have lower efficacy than the CAR-T, but will be able to be used off-the shelf? Do you think the infection risks and continuous infusion schedule due to shorter half-life, in the case of Amgen’s drug, could hinder uptake?Added By: c_admin
An interesting perspective I thought was that maybe patients with a high MM burden could use ADCs as a bridging therapy to quickly reduce tumor load, and then use a CAR-T or bispecific to eliminate MRD for durable responses. What do you think about that?Added By: c_admin
To summarize, when looking at ADCs, CAR-Ts and bispecifics, how do you envision them being integrated into current treatment algorithms?Added By: c_admin
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