The NHS Scotland has approved elranatamab and teclistamab, two bispecific antibodies, for the treatment of multiple myeloma in patients who have received three or more prior lines of therapy. This decision offers a new treatment option for individuals with relapsed or refractory myeloma, a condition affecting approximately 24,000 people in the UK annually and causing over 3,000 deaths.
Graeme Caulfield, a 54-year-old myeloma patient, described the treatment as a "wonder drug," noting significant improvements after previously exhausting other treatment options. He is among the first in Scotland to receive the weekly injection, achieving remission.
Mechanism of Action
Elranatamab and teclistamab represent a novel class of myeloma drugs. These bispecific antibodies work by binding to both myeloma cells and T cells, facilitating the immune system's ability to recognize and destroy cancer cells. This mechanism aims to control the disease, alleviate symptoms, and improve patients' quality of life.
Clinical Trial Data
Approval was based on data from the MajesTEC-1 trial for teclistamab and the MagnetisMM-3 trial for elranatamab. The MajesTEC-1 trial reported an overall response rate of 63% with teclistamab. The MagnetisMM-3 trial demonstrated a 61% overall response rate for elranatamab.
Shelagh McKinlay, director of research and advocacy at Myeloma UK, emphasized the importance of these approvals, stating that elranatamab and teclistamab could be a lifeline for patients running out of treatment options. She noted the drugs have shown excellent results in clinical trials, allowing some patients who have never responded well to treatment to experience their first complete remission.
Myeloma Overview
Myeloma is the third most common type of blood cancer in the UK, with approximately 16 people diagnosed daily. Symptoms, including pain, broken bones, fatigue, and recurring infections, can be difficult to detect, often leading to delayed diagnosis. While incurable, myeloma is treatable in most cases, with about half of patients surviving five years or more and around one-third surviving ten years or more.
Treatment Context
Elranatamab and teclistamab are intended for patients who have previously received an immunomodulatory agent (e.g., lenalidomide), a proteasome inhibitor (e.g., bortezomib), and an anti-CD38 antibody (e.g., daratumumab). Teclistamab has received permanent NHS approval, while elranatamab has been granted interim approval, pending further data on long-term effectiveness from ongoing clinical trials. Myeloma UK will monitor the situation to advocate for permanent access to elranatamab.
