Modern Relapsed Myeloma Population Is Addressed in MajesTEC-9

Roberto Mina, MD, associate professor of hematology at the Winship Cancer Institute at Emory University, discussed the significance of the patient population of the MajesTEC-9 trial (NCT05572515) in patients with relapsed/refractory multiple myeloma.

Investigators in the phase 3 trial compared teclistamab (Tecvayli) with standard of care (SOC) in patients who had received 1 to 3 prior lines of therapy. Patients must have received including at least 2 consecutive cycles of an anti-CD38 monoclonal antibody and at least 2 consecutive cycles of lenalidomide (Revlimid) and not received any prior B-cell maturation antigen (BCMA)–targeted therapy.

Most patients are now exposed to these therapies in the first line and as maintenance therapy, and will become refractory to these agents, meaning they need a different mechanism of action for the best results when treating their relapse. Teclistamab redirects CD3+ T cells and leads to T-cell activation on BCMA-expressing malignant tumor cells. The comparator arm consisted of carfilzomib (Kyprolis) plus dexamethasone or pomalidomide (Pomalyst), bortezomib (Velcade), and dexamethasone, which are standard therapies with.

Mina also expressed that in addition to the highly favorable reduction in risk of progression of 71% which was reported, the 40% reduction in risk of death stands out from the early results of this trial. In addition to bispecific antibodies such as teclistamab, other immunotherapeutic approaches to treat relapsed/refractory multiple myeloma are being introduced such as chimeric antigen receptor T-cell therapy and antibody-drug conjugates. Knowing that overall survival benefit can be observed in trials suggests that earlier use of BCMA targeting is beneficial to patients rather than using standard therapies and waiting for later lines where it is currently approved.