Ep 2. The Advent of Bispecifics: MajesTEC-3, MajesTEC-9, and MonumenTAL-3
Rohit Gosain, MD
Rahul Gosain, MD, MBA
S. Vincent Rajkumar, MD
Rafael Fonseca, MD
Beth Faiman, CNP, PhD
Key Points
- The MajesTEC-3, MajesTEC-9, and MonumenTAL-3 trials showed bispecific antibody–based therapy improved outcomes for patients with relapsed or refractory multiple myeloma as early as the second line compared with standard options.
- More data are needed to determine the optimal bispecific antibody regimens for patients treated with daratumumab in the frontline setting.
Cohosts of the Oncology Brothers podcast, Rahul Gosain, MD, MBA, of Wilmot Cancer Institute, and Rohit Gosain, MD, of Roswell Park Comprehensive Cancer Center, hosted a discussion with Beth Faiman, CNP, PhD, of Cleveland Clinic; Rafael Fonseca, MD, of Mayo Clinic; and S. Vincent Rajjkumar, MD, of Mayo Clinic, to discuss the shifting treatment paradigm for patients with relapsed or refractory multiple myeloma. As part of the discussion, Drs. Faiman and Fonseca discussed the impact of the MajesTEC-3, MajesTEC-9, and MonumenTAL-3 trials and the emergent role of bispecific antibodies in multiple myeloma.
The MajesTEC-3 trial showed that teclistamab plus daratumumab improved progression-free survival (PFS) compared with daratumumab plus dexamethasone plus pomalidomide (DPd) or bortezomib for patients with multiple myeloma after 1 to 3 prior lines of therapy.
Subsequently, the MajesTEC-9 trial reported that teclistamab monotherapy improved PFS and overall survival compared with pomalidomide, bortezomib, and dexamethasone or carfilzomib and dexamethasone in patients with 1 to 3 prior lines of therapy. Most recently, the MonumenTAL-3 trial found talquetamab plus daratumumab with or without pomalidomide improved PFS compared with DPd in patients with at least 1 prior line of therapy.
Notably, the MajesTEC-3 population only included a small number of patients treated with daratumumab in prior lines of therapy, as daratumumab–based regimens became the standard of care in the frontline setting after the trial commenced. While the MajesTEC-9 data support the value of teclistamab monotherapy in patients previously treated with an anti-CD38 antibody, questions remain surrounding daratumumab refractoriness and the potential value of rechallenging with daratumumab after relapse, said Dr. Fonseca.
Overall, the data from MajesTEC-3, MajesTEC-9, and MonumenTAL-3 establish bispecific antibody–based regimens as a preferred treatment option for multiple myeloma at first relapse, with outcomes comparable to available chimeric antigen receptor T-cell therapy. Moving forward, community oncologists should consider how to implement bispecific antibodies and manage related toxicities in their practice, said Dr. Fonseca.