Novel immunotherapies in multiple myeloma - chances and challenges

Abstract

In this review article, we summarize the latest data on antibody-drug conjugates, bispecific T-cell-engaging antibodies, and chimeric antigen receptor T cells in the treatment of multiple myeloma. We discuss the pivotal questions to be addressed as these new immunotherapies become standard agents in the management of multiple myeloma. We also focus on the selection of patients for these therapies and speculate as to how best to individualize treatment approaches. We see these novel immunotherapies as representing a paradigm shift. However, despite the promising preliminary data, many open issues remain to be evaluated in future trials.

Figure 1.

Mode of action illustrated for antibody-drug conjugates, T-cell-engaging antibodies and chimeric antigen receptor T cells. MMAF: monomethyl auristatin F; MM: multiple myeloma; BCMA: B-cell maturation antigen; TCR: T-cell receptor.

Figure 2.

Our view on potential patient selection as a basis for further discussion. CAR T: chimeric antigen receptor T cells; TCE: T-cell-engaging antibodies; ADC: antibodydrug conjugate; CRS: cytokine release syndrome; GFR: glomerular filtration rate; MM: multiple myeloma; ECOG: Eastern Cooperative Oncology Group performance status; CNS: central nervous system; PCL: plasma cell leukemia; EMD: extramedullary disease.