If you’ve tried other multiple myeloma treatments and they’re not working, your doctor may suggest immunotherapy. One type of immunotherapy uses monoclonal antibodies made in a lab to boost your immune system or change how it works. Monoclonal antibodies target certain proteins found on myeloma cells.
What Monoclonal Antibodies Are Used to Treat Multiple Myeloma?
There are a handful, most of which your doctor gives you through an IV in your vein. They are:
Elotuzumab (Empliciti). This drug does two things: It spurs the growth of your immune system’s natural “killer” cells and tags myeloma cells with the SLAMF7 protein. This makes it easier for your natural killer cells to recognize and kill the myeloma cells. Doctors usually combine it with lenalidomide (Revlimid) or pomalidomide (Pomalyst), as well as the steroid dexamethasone.
Daratumumab(Darzalex) or daratumumab hyaluronidase (Darzalex Faspro). This antibody kills myeloma cells directly and tags the CD38 protein they make, which helps your immune system recognize and attack them. If you’re newly diagnosed, your doctor may use it with:
- Bortezomib (Velcade), melphalan (Alkeran), and prednisone
- Lenalidomide (Revlimid) and dexamethasone
- Bortezomib, thalidomide (Thalomid), and dexamethasone
If your multiple myeloma is hard to treat or you’ve had it before and it’s relapsed, or come back, your doctor may recommend daratumumab along with:
- Lenalidomide and dexamethasone
- Carfilzomib (Kyprolis) and dexamethasone
- Pomalidomide (Pomalyst) and dexamethasone
Or they may use it alone if you’ve already tried these other therapies.
Isatuximab (Sarclisa). This drug works the same way as daratumumab. Doctors usually combine it with dexamethasone and carfilzomib or pomalidomide to treat those who’ve tried at least one other therapy.
Belantamab mafodotin-blmf (Blenrep). This is a type of medication known as an antibody-drug conjugate. That’s a monoclonal antibody connected to a chemotherapy drug. The antibody looks for the BCMA protein on myeloma cells and attaches to them, bringing the chemotherapy directly to the cancer cells. Doctors mainly give it to people who’ve already tried at least four other treatments for their multiple myeloma.
Teclistamab-cqyv(Tecvayli). Teclistamab is a human bispecific monoclonal antibody that forms a bridge between myeloma cells and T cells. It works similarly to belantamab by recognizing the BCMA and triggering a series of events that leads to myeloma cell death.
Doctors give all these monoclonal antibody treatments via your vein through an IV, except for Darzalex Faspro and Tacvayli. These are given as shots under your skin, usually around your belly.
What Are Side Effects of Monoclonal Antibodies?
Side effects from monoclonal antibodies can occur while you’re getting the drug or several hours later. Possible side effects include:
- Fatigue
- Feeling dizzy
- Headache
- Rash
- Nausea
- Fever
- Back pain
- Coughing
- Wheezing
- Trouble breathing
- Tightness in the throat
- A runny or stuffy nose
- Peripheral neuropathy (weakness or numbness in the hands and feet)
- Lack of appetite
- Diarrhea
- Constipation
Daratumumab and daratumumab hyaluronidase side effects can be more severe. These include:
- Swelling, itching, and redness where you got the shot
- Low oxygen levels
- Trouble breathing
- High blood pressure
- Lung spasms
To help avoid this, you’ll likely be given these before your treatment:
- Antihistamines
- Something to lower fever
- Steroids before your Darzalex IV
After treatment, your doctor may give you corticosteroid pills to lower the risk of delayed reactions.
Monoclonal antibodies can also lower blood cell counts, which can have serious health effects. They include:
- Low white blood cells, which raises the risk of infections
- Low red blood cells, which can lead to anemia
- Low blood platelets, raising the risk of bruising and bleeding
Belantamab mafodotin-blmf can also lead to eye problems like:
- Blurry vision
- Dry eyes
- Vision loss
- Corneal damage
Because potential side effects are so severe, this drug is only available through a special program called BLENREP Risk Evaluation and Mitigation Strategies (REMS). It’s run by the company that makes the drug.
Teclistamab-cqyv also carries a "black box" warning because it can cause a life-threatening or fatal reaction called cytokine release syndrome (CRS) and for its possible toxic effects on the nervous system. Medications are given before the dose of teclistamab-cqyv to help protect against these reactions. It is also only available through a restricted program under REMS program as well.
Are Scientists Studying More Monoclonal Antibodies for Multiple Myeloma?
Yes. These include ones that also target the proteins CD38 and BCMA. Researchers are also studying two new monoclonal antibodies:
CJM112. This targets and binds another protein known as IL17A, which is also involved in other conditions such as psoriasis and multiple sclerosis.
BMS-986016. This targets a specific gene known as a lymphocyte activation gene-3 and has been studied to treat other cancers, such as melanoma.
Researchers are also studying a different class of antibodies known as checkpoint inhibitors. Rather than just flagging cells to destroy them, checkpoint inhibitors boost your immune system’s ability to find and kill myeloma cells. They affect certain proteins on the surface of a myeloma cell that help them avoid your immune system. Once they do that, your immune system springs into action and attacks myeloma cells.
Doctors have successfully used checkpoint inhibitors in people with solid tumors, but scientists have not studied them closely yet in people with multiple myeloma. Early research suggests they’re not effective when used alone. But they may work better if they’re combined with other types of multiple myeloma drugs such as proteasome inhibitors.
