Establishing BCMA-Targeted Therapy as the Second-Line Myeloma Standard of Care

Roberto Mina, MD, of Winship Cancer Institute of Emory University, discusses the significant clinical impact of the MajesTEC-9 trial (NCT05572515) at the 2026 ASCO meeting, highlighting the superior efficacy of teclistamab (Tecvayli) over standard multiple myeloma treatments. The trial demonstrated a 40% reduction in the risk of death for patients receiving the B-cell maturation antigen (BCMA)-targeted bispecific antibody. This underscores that introducing teclistamab early in the myeloma treatment history not only prolongs progression-free survival but fundamentally improves overall survival.

These findings complement data from the MajesTEC-3 trial (NCT05083169) of teclistamab plus daratumumab (Darzalex) in the second line and beyond, solidifying the clinical consensus that BCMA-targeted agents should become the standard of care in the second-line setting. Multiple studies have now consistently demonstrated that targeting BCMA at this stage yields superior response rates and extends patient survival compared to historical standards.

When transitioning to this new paradigm, physicians must carefully weigh the choice of modality—specifically deciding between a “one-and-done” CAR T-cell infusion or a continuous bispecific antibody like teclistamab. This decision should be nuanced, factoring in unique patient demographics, underlying disease characteristics, institutional drug access, and individual patient preferences.

Finally, Mina addresses potential hesitation regarding the adverse event profiles of these potent immunotherapies. Although adverse events require vigilance, an expanding body of medical literature and conference abstracts currently presented at ASCO provides clear guidelines on toxicities. Because toxicities can be effectively mitigated through established, standardized care management protocols, clinicians should confidently utilize these agents. The definitive survival advantages observed in recent trials clearly argue for the immediate integration of BCMA-targeted therapies into early relapse strategies.