LeBow Institute for Myeloma Therapeutics and Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA, United States.
Harvard Medical School, Boston, MA, United States.
Front Immunol. 2018 Aug 10;9:1821. doi: 10.3389/fimmu.2018.01821. eCollection 2018.
The approval of the first two monoclonal antibodies targeting CD38 (daratumumab) and SLAMF7 (elotuzumab) in late 2015 for treating relapsed and refractory multiple myeloma (RRMM) was a critical advance for immunotherapies for multiple myeloma (MM). Importantly, the outcome of patients continues to improve with the incorporation of this new class of agents with current MM therapies. However, both antigens are also expressed on other normal tissues including hematopoietic lineages and immune effector cells, which may limit their long-term clinical use. B cell maturation antigen (BCMA), a transmembrane glycoprotein in the tumor necrosis factor receptor superfamily 17 (TNFRSF17), is expressed at significantly higher levels in all patient MM cells but not on other normal tissues except normal plasma cells. Importantly, it is an antigen targeted by chimeric antigen receptor (CAR) T-cells, which have already shown significant clinical activities in patients with RRMM who have undergone at least three prior treatments, including a proteasome inhibitor and an immunomodulatory agent. Moreover, the first anti-BCMA antibody-drug conjugate also has achieved significant clinical responses in patients who failed at least three prior lines of therapy, including an anti-CD38 antibody, a proteasome inhibitor, and an immunomodulatory agent. Both BCMA targeting immunotherapies were granted breakthrough status for patients with RRMM by FDA in Nov 2017. Other promising BCMA-based immunotherapeutic macromolecules including bispecific T-cell engagers, bispecific molecules, bispecific or trispecific antibodies, as well as improved forms of next generation CAR T cells, also demonstrate high anti-MM activity in preclinical and even early clinical studies. Here, we focus on the biology of this promising MM target antigen and then highlight preclinical and clinical data of current BCMA-targeted immunotherapies with various mechanisms of action. These crucial studies will enhance selective anti-MM response, transform the treatment paradigm, and extend disease-free survival in MM.
2015 年末,两种靶向 CD38(达雷妥尤单抗)和 SLAMF7(埃罗妥珠单抗)的单克隆抗体获得批准,用于治疗复发/难治性多发性骨髓瘤(RRMM),这是多发性骨髓瘤免疫治疗的重大进展。重要的是,随着这类新药物与当前 MM 治疗方法的结合,患者的预后仍在不断改善。然而,这两种抗原也在其他正常组织(包括造血谱系和免疫效应细胞)上表达,这可能限制了它们的长期临床应用。B 细胞成熟抗原(BCMA)是肿瘤坏死因子受体超家族 17(TNFRSF17)中的一种跨膜糖蛋白,在所有患者的骨髓瘤细胞中均高表达,但除正常浆细胞外,在其他正常组织中不表达。重要的是,它是嵌合抗原受体(CAR)T 细胞的靶点,在至少接受过三种治疗(包括蛋白酶体抑制剂和免疫调节剂)的 RRMM 患者中,已经显示出显著的临床活性。此外,首个抗 BCMA 抗体-药物偶联物在至少接受过三种治疗(包括抗 CD38 抗体、蛋白酶体抑制剂和免疫调节剂)失败的患者中也取得了显著的临床反应。FDA 于 2017 年 11 月授予这两种针对 BCMA 的免疫疗法突破性治疗认定,用于治疗 RRMM 患者。其他有前途的基于 BCMA 的免疫治疗大分子药物,包括双特异性 T 细胞衔接子、双特异性分子、双特异性或三特异性抗体,以及改进型下一代 CAR T 细胞,在临床前甚至早期临床研究中也显示出对 MM 具有很高的活性。在这里,我们重点关注这一有前途的 MM 靶抗原的生物学特性,然后重点介绍具有不同作用机制的当前 BCMA 靶向免疫疗法的临床前和临床数据。这些关键研究将增强对 MM 的选择性抗应答,改变治疗模式,并延长 MM 的无病生存期。
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