Study Analysis Adds Insight on Teclistamab for MM with Prior BCMA-Directed Therapy

Retrospective analysis of a multicenter study’s results adds insight into the utility of teclistamab to treat relapsed or refractory multiple myeloma (MM) in patients who have already undergone B-cell maturation antigen (BCMA)-directed therapy. The analysis was published in Blood Cancer Journal.

First author of the analysis Danai Dima, MD, from Fred Hutchinson Cancer Center in Seattle, Washington, wrote with colleagues that their findings “suggest that teclistamab can provide clinically meaningful improvement in the outcomes of patients with RRMM [relapsed or refractory MM] and prior anti-BCMA therapy exposure, an expanding population with an urgent need for effective treatments.”

The subject study was conducted with data from 13 academic centers in the US Multiple Myeloma Immunotherapy Consortium and included 385 patients with relapsed or refractory MM. This total cohort had a median age of 68 years, 47% of the patients were women, 34% were non-white, and 37% were penta-class refractory. 50% had previously been exposed to BCMA-directed therapy, and among these patients 51% were treated with only chimeric antigen receptor (CAR) T-cell therapy, 24% with only antibody-drug conjugate (ADC), 19% with both modalities, 3% with only bispecific antibodies, and 3% with other combinations.

The analysis performed on the study involved two cohorts; patients with prior exposure to BCMA-directed therapy versus patients without. Both received standard of care subcutaneous teclistamab in step-up doses of 0.06 and 0.3 mg/kg, a full dose of 1.5 mg/kg, and then subsequent dosing frequency as set by the managing physician.

The researchers found in the patients with prior exposure to BCMA-directed therapy that the overall response rate (ORR) was lower, at 48.7% versus 61.5% (P = 0.012), as was median progression-free survival (PFS) at 4.6 versus 8.2 months (P = 0.017). Their multivariable analysis determined, however, that receipt of a prior BCMA-directed therapy was not independently associated with ORR or PFS (P = 0.057) or PFS (P = 0.1).

In the cohort of patients who had prior exposure to BCMA-directed therapy, the researchers found no significant differences in PFS when the patients were stratified by the number of prior therapies, the types received, the type most recently received, or the depth of response to the most recently received therapy. They also found the optimal cut-off for time elapsed since the last exposure to BCMA-directed therapy to initiating teclistamab to be 8.7 months; patients with more than 8.7 months since their last exposure had greater median PFS than those with less than 8.7 months, at 8.1 months versus 2.5 months, respectively (P = 0.001).

In remarks forwarded to Blood Cancers Today, Dr. Dima emphasized as an important finding that “the timing of teclistamab initiation appears to influence outcomes; initiating teclistamab ≥9 months after the last BCMA-DT [BCMA-directed therapy] exposure was associated with improved PFS.”

“Collectively, these results support the use of teclistamab in patients with prior BCMA-DT exposure, particularly in those whose prior therapy was not a bispecific antibody,” Dr. Dima concluded in her forwarded remarks.