Table 1.
Currently approved targeted therapy for relapsed/refractory multiple myeloma (RRMM).
| Category | Mechanism of Action | Drugs | Indications in Multiple Myeloma and RRMM | Notes |
|---|---|---|---|---|
| Immuno-modulatory drugs | Marks Ikaros and Aiolos transcription factors for degradation | Lenalidomide (Revlimid®) |
With dex, as treatment for adult pts and as maintenance following HSCT | Oral; thalidomide derivatives, contra-indicated in pregnancy |
| Pomalidomide (Pomalyst®) | With dex, in pts who have had ≥2 prior therapies including lenalidomide and a PI, with disease progression ≤60 days of completing last therapy | |||
| Proteasome inhibitors | Prevents breakdown of pro-apoptotic proteins | Bortezomib (Velcade®) | Adult pts with multiple myeloma | IV or SC |
| Carfilzomib (Kyprolis®) | Adult RRMM pts who have had ≥1 prior therapy | IV | ||
| Ixazomib (Ninlaro®) | With lenalidomide + dex in pts who have had ≥1 prior therapy | Oral | ||
| Monoclonal antibodies | Anti-CD38 | Daratumumab (Darzalex®) | With lenalidomide or carfilzomib + dex in RRMM pts who have had 1–3 prior therapies; with pomalidomide + dex in pts who have had ≥2 prior therapies including lenalidomide and PI; as monotherapy in pts who have had ≥3 prior therapies including PI and IMiD or are double-refractory to PI and IMiD | IV, SQ |
| Isatuximab (Sarclisa®) | With pomalidomide + dex in adult pts who have had ≥2 prior therapies including lenalidomide and PI; with carfilzomib + dex in adult RRMM pts who have had 1–3 prior therapies | IV | ||
| Anti-SLAMF7 | Elotuzumab (Empliciti®) | With lenalidomide + dex in adult pts who have had 1–3 prior therapies; with pomalidomide + dex in adult pts who have had ≥2 prior therapies including lenalidomide and PI | IV | |
| XPO1 inhibitor | Forces nuclear retention of TSP | Selinexor (Xpovio®) | With bortezomib + dex in adult pts who have had ≥1 prior therapy; with dex in adult RRMM pts who have had ≥4 prior therapies, refractory to ≥2 PIs, ≥2 IMiDs, and anti-CD38 Mab | Oral |
| Bispecific antibodies (CD3 T cell engagers) | BCMA-directed | Teclistamab (Tecvayli®) | Adult RRMM pts who have had ≥4 prior therapies including PI, IMiD, and anti-CD38 Mab | SC; boxed warning: CRS, neurotoxicity |
| Elranatamab (Elrexfio™) | ||||
| GPRC5D-directed | Talquetamab (Talvey™) | |||
| CAR-T cells | BCMA-directed | Ide-cel (Abecma®) | Adult RRMM pts who have had ≥2 prior therapies including IMiD, PI, and anti-CD38 Mab | IV; boxed warning: CRS, HLH/MAS, neurotoxicity |
| Cilta-cel (Carvykti®) | Adult RRMM pts who have had ≥1 prior therapy including IMiD, PI, and anti-CD38 Mab | IV; boxed warning: CRS, Parkinsonism, GBS, HLH/MAS, neurotoxicity |
BCMA = B-cell maturation antigen; CAR = chimeric antigen receptor; Cilta-cel = ciltacabtagene autoleucel; CRS = cytokine release syndrome; dex = dexamethasone; GBS = Guillain-Barre syndrome; HLH/MAS = hemophagocytic lymphohistiocytosis/macrophage activation syndrome; HSCT = hematopoietic stem cell transplant; Ide-cel = idecabtagene vicleucel; IMiD = immunomodulatory drug; IV = intravenous; Mab = monoclonal antibody; PI = proteasome inhibitor; pts = patients; SC = subcutaneous; TSP = tumor suppression proteins.