Department of Medicine, Division of Oncology-Hematology, NYU Long Island School of Medicine, New York, United States of America.
NYU Perlmutter Cancer Center, New York, United States of America.
Expert Rev Hematol. 2021 Apr;14(4):377-389. doi: 10.1080/17474086.2021.1909469. Epub 2021 Apr 8.
Survival in multiple myeloma (MM) has improved due to the ongoing revolution of therapeutic approaches. Nevertheless, many patients relapse, and additional novel approaches are required to prolong remissions and prevent disease progression.
Considering the success of monoclonal antibodies (mAbs) against CD38 and SLAMF7 in relapsed/refractory MM (R/R MM), additional antigens expressed on malignant plasma cells are being investigated as treatment targets. Among these, many trials are focusing on B cell maturation antigen (BCMA), using either antibody-drug conjugates (ADCs), bispecific T cell engagers (TCE), or chimeric antigen receptor T cells (CAR-T). Other potential targets include the myeloma markers CD138, GPRC5D, FcRH5, the plasma cell differentiating factors APRIL, TACI and BAFF, and the immune checkpoint proteins CD47 and TIGIT. Additionally, novel immunomodulatory Cereblon E3 Ligase Modulators (CELMoDs) offer the potential to overcome resistance to conventional immunomodulatory agents. Based upon PubMed and abstract searches primarily from the past 4 years, here we review the data supporting novel immunotherapies for R/R MM.
Overcoming disease resistance remains a challenge in R/R MM. Novel therapeutic approaches targeting MM antigens and/or enhancing immune cell function offer the potential to prolong survival and are actively being investigated in clinical trials.
由于治疗方法的不断革新,多发性骨髓瘤(MM)患者的生存率得到了提高。然而,许多患者会复发,因此需要新的治疗方法来延长缓解期并防止疾病进展。
鉴于针对 CD38 和 SLAMF7 的单克隆抗体(mAbs)在复发/难治性 MM(R/R MM)中的成功,目前正在研究恶性浆细胞上表达的其他抗原作为治疗靶点。在这些靶点中,许多试验都集中在 B 细胞成熟抗原(BCMA)上,使用抗体药物偶联物(ADC)、双特异性 T 细胞衔接器(TCE)或嵌合抗原受体 T 细胞(CAR-T)。其他潜在的靶点包括骨髓瘤标志物 CD138、GPRC5D、FcRH5、浆细胞分化因子 APRIL、TACI 和 BAFF 以及免疫检查点蛋白 CD47 和 TIGIT。此外,新型免疫调节 cereblon E3 连接酶调节剂(CELMoD)有可能克服对常规免疫调节剂的耐药性。基于主要来自过去 4 年的 PubMed 和摘要检索,我们在此综述了支持 R/R MM 新型免疫疗法的数据。
克服疾病耐药性仍然是 R/R MM 的一个挑战。针对 MM 抗原和/或增强免疫细胞功能的新型治疗方法有可能延长生存期,目前正在临床试验中进行积极研究。