I wouldn’t with multiple myeloma on anyone, and goodness knows those first two years were not fun. Sitting here in MRD- land, however, I can take joy in the excitement of the FDA approving a new multiple myeloma drug.
What Is the Latest Multiple Myeloma Drug?
All right stick with me here folks. The science name of the newest multiple myeloma drug is teclistamab-cqyv.
If you are more than a few years into myeloma treatment you might have caught the ‘mab’ there at the end of the drug’s name. So, welcome a new member into the daratumumab and elotuzumab family. (There’s one more -mab, but I can’t recall it well enough find it with Google. Maybe I’ll come back to this when I remember.) Like daratumumab and elotuzumab, teclistamab-cqyv gets a more palatable name brand. Looks like they are calling it Tecvayli. I have no idea how the pronunciation works on that.
What Does Tecvali Do?
One of the oncologists I know calls them “me too” drugs. That is drugs that are just a little bit better at doing the same thing other drugs already do. Doctors push these “new” drugs because they are technically better when what they really do is create a new high-price drug with a seven-year monopoly.
I am not a doctor, and I didn’t stay at a Holiday Inn Express last night either, but here is what Tecvali seems to do.
The press release from Janssen Biotech says Tecvali is, “the first bispecific B-cell maturation antigen-directed CD3 T-cell engager.”
Whew! That’s a mouthful.
Basically, Tecvali is designed to bind to both cancerous plasma cells (BCMA), and T-cells via CD3. The idea is that BCMA proteins are more common on myeloma cells than healthy plasma cells. From here it becomes a math problem. If Tecvali kills 1,000 myeloma cells for ever 1 healthy cell, that’s a good trade off even if the overall effect also reduces healthy plasma cells.
Is Tecvali CAR T?
Nope. CAR T-cell therapies like ide-cel and cilta-cel do also target BCMA, but they are completely different mechanisms and must be developed from the patient’s own cells and take 5 to 6 weeks to prepare. Tecvali is a more standard drug. The same formula gets administered to everyone.
How To Take Tecvali
Tecvali is administered as an infusion. As of now, patients require weekly infusions of Tecvali.
The good news is that there was a positive response from the majority of trial patients.
Who Gets Tecvali
In what has quickly become standard procedure, Tecvali is approved for use in patients with relapsed or refractory myeloma who have already had four lines of treatment. Basically, if nothing else has worked, you can try Tecvali. After all, if you would get sick and die without the treatment, then there is really no complaint if you get sick and die with the treatment. They essentially turn the least viable multiple myeloma patients into a bigger clinical trial. After collecting a bunch of data and nailing down dosages, they will apply for approval to treat patients who have tried three lines, and eventually for everyone.