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Evolving Concepts on Novel Targeted Therapies in the Treatment of Multiple Myeloma

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Oncology".

Deadline for manuscript submissions: closed (25 March 2022) | Viewed by 15996

Special Issue Editors


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Guest Editor
Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
Interests: multiple myeloma; Waldenström’s macroglobulinemia; AL amyloidosis; liver cancer; meta-analysis; immunotherapy
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Guest Editor
Department of Clinical Therapeutics, School of Medicine, University of Athens, Athens, Greece
Interests: multiple myeloma; bone marrow; hematological malignancies; hematologic diseases; fracture; osteoporosis; bone biology; bone metabolism; myelodysplastic syndromes

Special Issue Information

Dear Colleagues,

Multiple myeloma (MM) is characterized by the uncontrollable proliferation of plasma cells and the excessive production of a specific type of immunoglobulin. The immune system is deregulated in MM and, thus, targeted treatments which aim to restore immune function are a promising therapeutic strategy. The first approach is to use monoclonal antibodies that recognize specific antigens on the surface of myeloma cells, such as CD38 and B-cell maturation antigen (BCMA). Upon binding to their target, monoclonal antibodies activate the immune cells to destroy the malignant cell. Anti-CD38, anti-SLAMF7 and anti-BCMA molecules, as components of highly effective combination regimens, have been approved in both newly diagnosed and relapsed/refractory patients and have significantly changed the myeloma treatment landscape in recent years. Another strategy is to use antibodies that bind to both a molecule on the surface of the myeloma cell and another molecule on the surface of a T-cell (bispecific antibodies). Consequently, the T-cell comes close to and recognizes the myeloma cell. These techniques have shown promising results in heavily pre-treated patients.

Antibody therapy has significantly enhanced the armamentarium against MM. However, the integration of novel targeted therapies into the treatment of MM remains challenging, especially when no direct comparisons in phase 3 trials have been conducted. Further research should focus on tailoring the combination regimens based on disease and patient characteristics in order to optimize the efficacy and safety. Another aspect is the role of minimal residual disease (MRD), which aims to guide therapeutic decisions with novel targeted agents. Lastly, the cost-effectiveness of novel agents has to be taken into consideration, and the best means of determining the optimal clinical benefit according to the anticipated cost of treatment remains elusive.

This Special Issue will address the most recent and relevant scientific findings regarding the evolving concepts and challenges in novel targeted therapies in the treatment of MM.

Dr. Ioannis Ntanasis-Stathopoulos
Prof. Dr. Evangelos Terpos
Guest Editors

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Keywords

  • multiple myeloma
  • targeted therapy
  • monoclonal antibodies
  • immunotherapy
  • new drugs
  • drug combinations
  • bispecific antibodies
  • chimeric antigen receptor T-cells
  • minimal residual disease
  • pharmacoeconomics

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Published Papers (3 papers)

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Research

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10 pages, 812 KiB  
Article
The CRBN, CUL4A and DDB1 Expression Predicts the Response to Immunomodulatory Drugs and Survival of Multiple Myeloma Patients
by Joanna Barankiewicz, Anna Szumera-Ciećkiewicz, Aleksander Salomon-Perzyński, Paulina Wieszczy, Agata Malenda, Filip Garbicz, Monika Prochorec-Sobieszek, Irena Misiewicz-Krzemińska, Przemysław Juszczyński and Ewa Lech-Marańda
J. Clin. Med. 2021, 10(12), 2683; https://doi.org/10.3390/jcm10122683 - 18 Jun 2021
Cited by 5 | Viewed by 2870
Abstract
Immunomodulatory drugs (IMiDs) are effective in the treatment of multiple myeloma (MM), myelodysplastic syndrome with deletion of chromosome 5q and other haematological malignancies. Recent studies showed that IMiDs bind to cereblon (CRBN), a substrate receptor of the CRL4–CRBN complex, to induce the ubiquitination [...] Read more.
Immunomodulatory drugs (IMiDs) are effective in the treatment of multiple myeloma (MM), myelodysplastic syndrome with deletion of chromosome 5q and other haematological malignancies. Recent studies showed that IMiDs bind to cereblon (CRBN), a substrate receptor of the CRL4–CRBN complex, to induce the ubiquitination and degradation of IKZF1 and IKZF3 in MM cells, contributing to their anti-myeloma activity. We aimed to determine whether the CRL4–CRBN complex proteins’ expression predicts the prognosis of MM patients treated with IMiDs. Here, we evaluated the expression of CRL4–CRBN complex proteins and their downstream targets with immunohistochemistry (IHC) staining in 130 bone marrow samples from MM patients treated with thalidomide or lenalidomide-based regimens. We found that the expression of CRBN and CUL4A was associated with the superior IMiD-based treatment response (p = 0.007 and p = 0.007, respectively). Moreover, the CUL4A expression was associated with improved PFS (HR = 0.66, 95% CI 0.44–0.99; p = 0.046) and DDB1 expression showed a negative impact on OS both in the univariate (HR = 2.75, 95% CI 1.65–4.61; p = 0.001) and the multivariate (HR 3.67; 95% CI 1.79–7.49; p < 0.001) analysis. Overall, our data suggest that the expression of DDB1, CUL4A and CRBN assessed by IHC predicts the clinical course of MM patients and identifies patients with a high probability of responding to IMiD-based therapy. Full article
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Review

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19 pages, 7104 KiB  
Review
Current State of the Art and Prospects of T Cell-Redirecting Bispecific Antibodies in Multiple Myeloma
by Mashhour Hosny, Christie P. M. Verkleij, Jort van der Schans, Kristine A. Frerichs, Tuna Mutis, Sonja Zweegman and Niels W. C. J. van de Donk
J. Clin. Med. 2021, 10(19), 4593; https://doi.org/10.3390/jcm10194593 - 6 Oct 2021
Cited by 14 | Viewed by 5830
Abstract
Multiple myeloma (MM) patients eventually develop multi-drug-resistant disease with poor survival. Hence, the development of novel treatment strategies is of great importance. Recently, different classes of immunotherapeutic agents have shown great promise in heavily pre-treated MM, including T cell-redirecting bispecific antibodies (BsAbs). These [...] Read more.
Multiple myeloma (MM) patients eventually develop multi-drug-resistant disease with poor survival. Hence, the development of novel treatment strategies is of great importance. Recently, different classes of immunotherapeutic agents have shown great promise in heavily pre-treated MM, including T cell-redirecting bispecific antibodies (BsAbs). These BsAbs simultaneously interact with CD3 on effector T cells and a tumor-associated antigen on MM cells, resulting in redirection of T cells to MM cells. This leads to the formation of an immunologic synapse, the release of granzymes/perforins, and subsequent tumor cell lysis. Several ongoing phase 1 studies show substantial activity and a favorable toxicity profile with BCMA-, GPRC5D-, or FcRH5-targeting BsAbs in heavily pre-treated MM patients. Resistance mechanisms against BsAbs include tumor-related features, T cell characteristics, and impact of components of the immunosuppressive tumor microenvironment. Various clinical trials are currently evaluating combination therapy with a BsAb and another agent, such as a CD38-targeting antibody or an immunomodulatory drug (e.g., pomalidomide), to further improve response depth and duration. Additionally, the combination of two BsAbs, simultaneously targeting two different antigens to prevent antigen escape, is being explored in clinical studies. The evaluation of BsAbs in earlier lines of therapy, including newly diagnosed MM, is warranted, based on the efficacy of BsAbs in advanced MM. Full article
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18 pages, 319 KiB  
Review
BCMA in Multiple Myeloma—A Promising Key to Therapy
by Martina Kleber, Ioannis Ntanasis-Stathopoulos and Evangelos Terpos
J. Clin. Med. 2021, 10(18), 4088; https://doi.org/10.3390/jcm10184088 - 10 Sep 2021
Cited by 31 | Viewed by 6390
Abstract
Despite the discoveries of numerous agents including next generation proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies, multiple myeloma (MM) remains an incurable disease. The field of myeloma treatment in refractory or relapsed patients after standard therapy entered a new era due to the [...] Read more.
Despite the discoveries of numerous agents including next generation proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies, multiple myeloma (MM) remains an incurable disease. The field of myeloma treatment in refractory or relapsed patients after standard therapy entered a new era due to the B-cell maturation antigen (BMCA) targeted approach. BCMA is a member of the tumor necrosis factor receptor family with high expression in mature B-lymphocytes and plasma cells. Given the understanding of BCMA mechanism of action in MM, BCMA plays a promising role as a therapeutic target. Several clinical trials are underway to evolve the current BCMA targeted treatment concept such as antibody-drug conjugates (ADCs), bispecific T cell engagers (BITEs) and chimeric antigen receptor (CAR) T cell therapy. Current results of representative BCMA trials may close the gap of the unmet clinical need to further improve the outcome of heavily pretreated MM patients with the potency to change the paradigm in newly diagnosed and refractory MM. This comprehensive review will give an update on various BMCA targeted treatment modalities (ADCs, BITEs, CAR T cell therapy) and its existing results on efficacy and safety from preclinical and clinical trials. Full article
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