CHARLIE BROWN: Someday we will die, Snoopy.
SNOOPY: True, but all the other days, we will not.
Snoopy’s philosophy resonates at ASH 2018 because of all the exciting information on immunotherapy. There are new approaches to the use of daratumumab with other agents in quadruple combinations that result in high rate of response in newly diagnosed multiple myeloma.
Amgen has developed a bi-specific protein antigen (BiTE) which brings together a tumor cell protein (CD3) and a killer T-cell protein (BCMA). This engagement of T-cells and tumor cells results in the myeloma cell death. BiTE (bi-specific T-cell engager) therapy is being studied in relapsing/refractory MM. This development is another modality of immunotherapy for treating multiple myeloma.
New developments for CAR T-cell therapy include new targets of the T-cells that enhance response. One of these agents is GPRC5D which induces T-cell lysis of low B-cell maturation antigen (BCMA) in MM. BCMA down-regulation can occur resulting in a less than optimal response to the engineered T-cells. The BCMA target in the myeloma can be variable and targeting another site or antigen may improve the response and affect outcome of MM.
These are a few of the exciting new treatments being presented at Ash 2018. Perhaps more important, these treatments bring us hope for more “other days” of which Snoopy so wisely reminds us of.