Multiple myeloma is a cancer of plasma cells, which are a type of antibody-producing B cell. Two immunotherapeutic agents are currently approved for the treatment of multiple myeloma.
Approved immunotherapeutic agents
Combination therapy/treatment algorithms
Approved immunotherapeutic agents (for multiple myeloma)
In 2015, two immunotherapeutic agents were approved for the treatment of multiple myeloma. Daratumumab (Darzalex, Janssen) is a monoclonal antibody that targets CD38, a surface antigen on multiple myeloma cells. It was approved as part of a combination therapy regimen to treat patients who have been treated with at least one other type of therapy, or as a single agent for patients who have been treated with at least three other types of therapy.
Multiple myeloma cells and natural killer cells express a surface protein called signaling lymphocytic activation molecule F7 (SLAMF7); this cell surface protein is not expressed by other (normal) cells. Elotuzumab (Empliciti, Bristol-Myers Squibb) is a monoclonal antibody that targets SLAMF7, and it is approved for the treatment of multiple myeloma in patients who have been treated with at least one other type of treatment.
Multiple myeloma combination therapy/treatment algorithms
The NCCN guidelines recommend the following preferred treatment regimens for patients with multiple myeloma who have been previously treated:
- Daratumumab as a single agent for patients who have failed three previous lines of treatment;
- Elotuzumab, lenalidomide, and dexamethasone;
- Vincristine, doxorubicin, and dexamethasone; or
- Vincristine, carmustine, melphalan, cyclophosphamide, and prednisone.
Current clinical trials for multiple myeloma
Several checkpoint inhibitors are currently being investigated for the treatment of multiple myeloma, including nivolumab, durvalumab, pembrolizumab and atezolizumab. An investigative agent called pidilizumab, a PD-1 inhibitor, is currently in phase 1/2 testing for the treatment of multiple myeloma. Other investigative agents include a dendritic cell vaccine, two peptide vaccines, several different types of CAR T-cell therapy and an interleukin-15 agonist called ALT-803.