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With more than 5,000 cases per year, multiple myeloma is constantly increasing. Faced with relapses or refractory forms, a conjugated antibody provides very encouraging results. Focus on this winning “targeted missile” strategy against cancer.
Multiple myeloma: a rare cancer that is constantly progressing
Multiple myeloma (or Kahler disease) is a hematologic malignancy, also called bone marrow cancer. It is characterized by the excessive proliferation in the bone marrow of a type of white blood cell called plasma cell, which has become abnormal. “There are approximately 5,500 new cases each year, with a slight predominance in men (54%). The average age of onset of this cancer is 72 years. Even if it is currently rare (2% of all cancers), its incidence is increasing and will continue to increase with the increase in life expectancy.” specifies Dr Xavier Leleu, hematologist in Poitiers.
In most cases, myeloma is a disease that tends to become chronic with the succession of several phases of remissions and relapses. Indeed, relapses generally occur after periods of remission whose duration varies. The disease can most often be treated several times. But for these patients who relapse or for whom treatment does not stop the progression of the disease, a new drug will be a game-changer.
The prowess of a targeted missile against cancer
Belantamab mafodotin (marketed as Blenrep®) is a conjugated antibody that binds to a protein called BCMA on myeloma cells and then delivers a chemotherapy drug to destroy the cell. This “guided missile” strategy is one of the major trends of ASCO 2024 and in the face of multiple myeloma, this compound has demonstrated its superiority over the two reference treatments currently available.
The DREAMM-7 clinical trial showed that a combination of belantamab mafodotin plus bortezomib and dexamethasone (a steroid) slowed the progression of multiple myeloma if the first treatment did not work compared to the combination of daratumumab plus bortezomib and dexamethasone.
As part of ASCO 2024, the DREAMM-8 study combines belantamab mafodotin with another common myeloma drug, pomalidomide (a drug that stimulates the immune system) and dexamethasone. And here again, it demonstrates the superiority of this drug. In detail: 300 patients with relapsed and refractory multiple myeloma whose disease had progressed after at least one prior treatment (including lenalidomide) were randomized to receive belantamab mafodotin plus pomalidomide and dexamethasone, or pomalidomide plus bortezomib and dexamethasone (one of the current standard treatments).
After a median follow-up of 22 months, the time before the disease progressed again (median progression-free survival – PFS) was not reached for participants who received the combination with the new drug, whereas it was 12.7 months for the group receiving standard treatment. In this area, the new compound therefore does twice as well!
Common but “manageable” ocular side effects
This type of treatment is not without side effects, but it does not affect patients’ quality of life any more than standard treatment. The main side effects are corneal (changes to the cornea, blurred vision, feeling of sand on the eyes, etc.) affecting 89% of treated patients.
“Ocular side effects are reversible and can be managed by adjusting or spacing the doses of bélantamab mafodotine and with some advice (no lenses, drops in the eyes, etc.). This allowed most patients to continue receiving and benefit from the study treatment.” specifies Dr Leleu.
Towards a new standard of care
Proof of the importance of these results, the two studies were published in the prestigious journal The New England Journal of Medicine. “The drug is administered intravenously, which does not require hospitalization, on a schedule that is normally monthly but can vary depending on the patient’s response. We may think that for some, 3 to 5 injections per year could be enough to control the disease.” specifies Dr Leleu who does not hide his enthusiasm at the idea of soon being able to have this treatment available for these patients.
Researchers will continue to follow study participants to see if patients live longer (overall survival data) and remain disease-free – this crucial data is not yet available. They will also continue to collect data to learn the median PFS and duration of response to treatment.
But these results are already very encouraging and could represent an important option for patients, or even the standard treatment for patients with multiple myeloma at the first and subsequent relapses. Next step: a probable European marketing authorization before discussions with the health authorities for reimbursement.