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多发性骨髓瘤治疗前沿的变革:寻找治愈方法的经验与挑战

Revolutions at the frontline of multiple myeloma treatment: lessons and challenges to finding a cure.

作者信息

Kort Jeries, Rivera Andrea, Senigarapu Sindhuja, Driscoll James J

机构信息

Division of Hematology and Oncology, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.

Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, United States.

出版信息

Front Oncol. 2025 Jun 20;15:1578529. doi: 10.3389/fonc.2025.1578529. eCollection 2025.


DOI:10.3389/fonc.2025.1578529
PMID:40626006
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12231495/
Abstract

Multiple myeloma (MM) is a cancer of bone marrow plasma cells. A noteworthy ensemble of therapies has been introduced over the past quarter century that exert antimyeloma activities through diverse mechanisms and achieve durable disease control in many patients. The discovery that proteasome inhibitors (PIs) and immunomodulatory drugs (IMiDs) target specific plasma cell features that reflect disease biology and exert antimyeloma activity led to transformative changes in treatment algorithms. Recently, advances in immunotherapy have emerged and represent a promising option with the potential to capture immunologic memory and yield more durable responses in MM patients. Idecabtagene vicleucel and ciltacabtagene autoleucel are chimeric antigen receptor (CAR) T-cell immunotherapies that attach to the extracellular domain of the B-cell maturation antigen (BCMA) and have demonstrated significant response rates in heavily-treated patients. These agents are FDA-approved for relapsed and/or refractory (RR)MM patients previously treated with PIs, IMiDs, and CD38-directed monoclonal antibodies. Most patients who receive CAR T-cell therapy relapse after prolonged or brief remission, and a more thorough understanding of the resistance mechanisms following CAR T-cell infusion is needed. Bispecific antibodies (BsAbs) are engineered to simultaneously bind to both cancer and immune cells and trigger a direct tumor-specific cytotoxic response. BsAbs and CAR T-cells are major histocompatibility complex (MHC)-independent approaches to treat MM and do not require T-cell receptor (TCR) specificity. Agents that target BCMA and G protein-coupled receptor class C group 5 member D (GPRC5D) demonstrate impressive clinical responses, while early-phase trials targeting FcRH5 are promising. Here, we provide a comprehensive overview of their individual efficacy, adverse effects, and limitations that impact broader application.

摘要

多发性骨髓瘤(MM)是一种骨髓浆细胞癌。在过去的四分之一世纪里,已经引入了一系列值得注意的治疗方法,这些方法通过不同机制发挥抗骨髓瘤活性,并在许多患者中实现了持久的疾病控制。蛋白酶体抑制剂(PIs)和免疫调节药物(IMiDs)靶向反映疾病生物学特征的特定浆细胞特性并发挥抗骨髓瘤活性,这一发现导致了治疗方案的变革性变化。最近,免疫疗法取得了进展,代表了一种有前景的选择,有可能捕捉免疫记忆并在MM患者中产生更持久的反应。idecabtagene vicleucel和ciltacabtagene autoleucel是嵌合抗原受体(CAR)T细胞免疫疗法,它们附着于B细胞成熟抗原(BCMA)的细胞外结构域,并在接受过大量治疗的患者中显示出显著的缓解率。这些药物已获得美国食品药品监督管理局(FDA)批准,用于先前接受过PIs、IMiDs和CD38定向单克隆抗体治疗的复发和/或难治性(RR)MM患者。大多数接受CAR T细胞治疗的患者在长期或短期缓解后复发,因此需要更深入地了解CAR T细胞输注后的耐药机制。双特异性抗体(BsAbs)经过设计,可同时结合癌细胞和免疫细胞,并引发直接的肿瘤特异性细胞毒性反应。BsAbs和CAR T细胞是治疗MM的主要组织相容性复合体(MHC)非依赖性方法,不需要T细胞受体(TCR)特异性。靶向BCMA和G蛋白偶联受体C类第5组成员D(GPRC5D)的药物显示出令人印象深刻的临床反应,而靶向FcRH5的早期试验也很有前景。在此,我们全面概述了它们各自的疗效、不良反应和影响更广泛应用的局限性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d9c1/12231495/760105d57872/fonc-15-1578529-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d9c1/12231495/0b02153d6d61/fonc-15-1578529-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d9c1/12231495/2ab2a51524ee/fonc-15-1578529-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d9c1/12231495/760105d57872/fonc-15-1578529-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d9c1/12231495/0b02153d6d61/fonc-15-1578529-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d9c1/12231495/2ab2a51524ee/fonc-15-1578529-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d9c1/12231495/760105d57872/fonc-15-1578529-g003.jpg

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Revolutions at the frontline of multiple myeloma treatment: lessons and challenges to finding a cure.

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本文引用的文献

[1]
The Real-World Outcomes of Relapsed/Refractory Multiple Myeloma Treated with Elotuzumab, Pomalidomide, and Dexamethasone.

Hematol Rep. 2024-9-30

[2]
Quadruplet therapy for newly diagnosed myeloma: comparative analysis of sequential cohorts with triplet therapy lenalidomide, bortezomib and dexamethasone (RVd) versus daratumamab with RVD (DRVd) in transplant-eligible patients.

Blood Cancer J. 2024-9-13

[3]
Immunoproteasome Activation Expands the MHC Class I Immunopeptidome, Unmasks Neoantigens, and Enhances T-cell Anti-Myeloma Activity.

Mol Cancer Ther. 2024-12-3

[4]
A roadmap towards improving outcomes in multiple myeloma.

Blood Cancer J. 2024-8-12

[5]
Comparative efficacy of ciltacabtagene autoleucel versus idecabtagene vicleucel in the treatment of patients with relapsed or refractory multiple myeloma previously treated with 2-4 prior lines of therapy: a matching-adjusted indirect comparison.

Curr Med Res Opin. 2024-9

[6]
A Belantamab Mafodotin Revival in Multiple Myeloma Therapy.

N Engl J Med. 2024-8-1

[7]
Unraveling the complexity of drug resistance mechanisms to SINE, T cell-engaging therapies and CELMoDs in multiple myeloma: a comprehensive review.

Cancer Drug Resist. 2024-6-26

[8]
The Evolving Role of Bridging Therapy during CAR-T Therapy.

Clin Hematol Int. 2024-7-16

[9]
Multiple myeloma.

Nat Rev Dis Primers. 2024-6-27

[10]
Isatuximab, Bortezomib, Lenalidomide, and Dexamethasone for Multiple Myeloma.

N Engl J Med. 2024-10-31

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