EHA 2015

Monoclonal antibodies and multiple myeloma

Prof Vincent Rajkumar - Mayo Clinic, Rochester, USA

There are two new drugs approved in the US that will soon be approved in most of Europe and elsewhere, those are carfilzomib and pomalidomide. But the most recent excitement surrounds monoclonal antibodies. We’ve had a publication in the New England Journal of Medicine just in the last two weeks showing that elotuzumab, it’s a monoclonal antibody against SLAMF7, improves the progression free survival of multiple myeloma patients significantly. There is another monoclonal antibody that is targeting CD38 called daratumumab which also has shown promise with a 30% response rate in patients who have failed everything. So these two monoclonal antibodies bring a lot of new hope to myeloma patients.

What is it about SLAMF7 and CD38 that make them good targets and offer the promise?

They are expressed to a very high level on plasma cells and very minimally on other cells so they provide us the opportunity to target the actual cancer cell without harming other normal cells. They both have been shown in phase II studies to be highly effective and, in the case of elotuzumab, in the phase III study an actual improvement in progression free survival.

And how much of a step forwards in efficacy could the use of such targeted agents make?

I think it can make a huge difference because the initial trials are trying to just establish that these drugs are active so they use them as single agents or in small combinations. But as we use them with our best combinations and early on in the disease course I think the impact is going to be higher. We also have other new drugs coming up – filanesib and LGH447 and others that have also shown activity. A drug that has been recently approved is panobinostat but even though that drug has problems I think it shows the potential value of HDAC inhibitors in the treatment of myeloma. So you’re going to see a lot more changes.