Predicting Response to BCMA Therapies to Fine-Tune Multiple Myeloma Treatment

Where we still fall behind

• B-cell maturation antigen (BCMA) is a promising target in high-risk relapsed/refractory multiple myeloma
• The field would benefit from further advancement and a better understanding of the baseline makeup of myeloma and the immune microenvironment
• Studies are investigating new targets in combination CAR T-cell therapy

Despite great progress in multiple myeloma treatment, most patients will inevitably relapse. New targeted therapies are needed, especially in high-risk relapsed/refractory multiple myeloma. B-cell maturation antigen (BCMA) is one such promising target, but we need to improve our ability to understand the makeup of myeloma at baseline, as well as the immune microenvironment, to predict which BCMA-focused therapies would provide the greatest benefit for each patient.

“One deficiency, for example, is we don’t even have a very good generally agreed upon assay to measure BCMA levels,” Dr. Robert Orlowski, chairman, ad interim, director of myeloma, and professor of medicine at MD Anderson Cancer Center, tells SurvivorNet Connect. “Because if you come out of a BCMA therapy with persistent expression of BCMA, then switching to another drug in that category may be reasonable.”

Studies are under way to determine whether combining CAR T-cell therapy with immunomodulatory drugs could offer an advantage, and to figure out which specific targets might result in the greatest survival benefits. While Dr. Orlowski acknowledges that combining treatments will bump up the cost, “I think that as with combination chemotherapies working better, there’s reason to expect the combination CAR T’s will also,” he says.