Novel r/r MM treatment shows promising efficacy, sustained durability

A novel therapy for relapsed or refractory multiple myeloma has shown promising efficacy and tolerability that could offer a new treatment approach, say researchers who will move to phase 2 testing.

Researchers collaborating from the US, Spain and France report in The Lancet that the bispecific antibody, teclistamab, which binds BCMA and CD3 to redirect T cells to multiple myeloma cells, also demonstrated a durability that deepened over time.

A phase 1 single arm trial tested three dosing strategies in 157 patients who were relapsed, refractory, or intolerant to established therapies.

The recommended phase 2 dose, once per week subcutaneous administration at 1500 μg/kg, after 60 μg/kg and 300 μg/kg step-up doses, was then trialled amongst 40 patients.

At that dose teclistamab exposure was maintained above target exposure levels, and consistent T-cell activation was reported, say investigators adding that no dose-limiting toxicity’s were reported.

The most common treatment-emergent adverse events were cytokine release syndrome in 28 (70%; all grade 1 or 2 events) and neutropenia in 26 (65%) patients (grade 3 or 4 in 16 [40%]).

The overall response rate amongst the 40 patients was 65% (95% CI 48−79). Some 58% achieved a very good partial response or better.

Meanwhile the median duration of response was not reached –  22 (85%) of 26 responders were alive and continuing treatment after 7·1 months’ median follow-up (IQR 5·1−9·1).

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Shingrix effective after HSCT

The non-live, adjuvanted recombinant zoster vaccine Shingrix can induce robust immune responses and reduce the risk of herpes zoster after haematopoletic stem cell transplant (HSCT), according to an international study that included Australian patients.

Robust humoral and cell-mediate immune (CMI) responses were elicited in a study involving 1846 adult auHSCT recipients across all age groups (18–49 and ≥50 years), who received two Shingrix doses 50–70 days post-transplant.

The robust CMI responses were maintained irrespective of underlying diseases in adults who had undergone autologous HSCT, according to findings published in Human Vaccines and Immunotherapeutics.

Vaccine efficacy against herpes zoster ranged between 42.5% and 82.5% across underlying diseases and was statistically significant in NHBCL and multiple myeloma patients, the study showed.

Convalescent plasma ineffective even when used early in COVID-19

After being shown to be ineffective when given late in the course of COVID-19 illness, convalescent plasma has now also been shown to have no effect on disease progression or outcomes when given early to high-risk acutely ill patients with the disease.

A US randomised trial that allocated 511 high risk COVID-19 patients (over 50 years of age with risk factors for poor outcomes) to  convalescent-plasma or placebo treatment within a week of onset of symptoms found no difference in rates of progression (30% vs 32%) or in rates of disease severity and death.

The study investigators said the rationale was that early administration of plasma with a high titre of neutralising antibodies against SARS-CoV-2 virus would be most likely to be effective before the development of the patient’s own antibody response.

However the results showed a lack of efficacy with this strategy, they concluded in NEJM.