How Monoclonal Antibodies Are Used for Multiple Myeloma

Monoclonal antibodies help your immune system recognize and attack myeloma cells. These drugs are often helpful when other therapies don’t work, you have a recurrence, or you aren’t eligible for stem cell therapy.
Multiple myeloma is a form of blood cancer with a talent for evading the immune system. Monoclonal antibodies are a type of immunotherapy because they change the way your immune system works.
This article discusses monoclonal antibodies for multiple myeloma, when they’re an option, and what you can expect from treatment.
Fast facts
Myeloma is cancer of plasma cells. Because the disease usually involves multiple sites at diagnosis, it’s called multiple myeloma.
Asymptomatic myeloma is called smoldering myeloma. It usually doesn’t require treatment.
Smoldering myeloma does require careful monitoring. About half of all cases progress to active myeloma within 5 years.
Myeloma is relatively rare. It represents about 1.8% of all new cancer cases in the United States.
The median age at diagnosis is 69.
Myeloma is more common in men than women and in people of African American descent.
Other risk factors include genetics, obesity, alcohol consumption, and exposure to insecticides, organic solvents, Agent Orange, and radiation.
Only 3.6% of cases are local stage at diagnosis.
The 5-year relatival survival rate is 79.5% when diagnosed as local stage. It’s 59.0% when diagnosed as later stage.
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What are monoclonal antibodies?

What are monoclonal antibodies?
Your immune system makes antibodies to defend against antigens. The antibodies lock on to specific proteins to flag them for attack. Monoclonal antibodies are lab-made proteins, or “clones.”
Scientists design them to bind to a specific target on the surface of myeloma cells. Then, they either kill myeloma cells directly or flag the target so the immune system can see them.
There are three monoclonal antibody drugs for multiple myeloma:
daratumumab (Darzalex): attaches to the CD38 antigen on myeloma cells
isatuximab (Sarclisa): attaches to the CD38 antigen on myeloma cells
elotuzumab (Empliciti): attaches to the SLAM7 antigen on myeloma cells
Antibody-drug conjugates are another class of agents. They’re a combination of monoclonal antibodies and chemotherapy drugs. The antibody binds to the antigen on the cancer cell. Then, the chemo drug destroys it.

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How are monoclonal antibodies used to treat myeloma?

How are monoclonal antibodies used to treat myeloma?
Most of the time, you’ll get monoclonal antibodies in combination with other therapies. You can get Darzalex alone if:
You’ve tried at least three other types of therapy. This includes a proteasome inhibitor and an immunomodulatory agent.
The myeloma is resistant to a proteasome inhibitor as well as an immunomodulatory agent.
Otherwise, you’ll get Darzalex in combination with other therapies. It’s approved for:
People who are newly diagnosed but not eligible for stem cell transplant.
Those who have relapsed or refractory multiple myeloma and have tried one to three other therapies.
You can also get Sarclisa in combination with other therapies. It’s approved for:
People who’ve had at least two other therapies. This includes lenalidomide (an immunomodulating agent) and a proteasome inhibitor.
Those with relapsed or refractory multiple myeloma, after trying one to three other types of therapy.
Empliciti is combined with other therapies. It’s for people who’ve had one to three other therapies.
Monoclonal antibodies or chemotherapy?
According to the American Cancer Society, chemotherapy was once a main treatment for multiple myeloma. But it’s less important now due to newer options. It’s still used along with other therapies. It also plays a significant role in stem cell transplant. Which one is right for you depends on factors such as:
age and overall health
whether you’re eligible for stem cell transplant
previous treatments, if any
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What’s it like to receive monoclonal antibodies for myeloma?

What’s it like to receive monoclonal antibodies for myeloma?
You get monoclonal antibodies for multiple myeloma through intravenous (IV) infusion. The process is similar to getting chemotherapy. It’s an outpatient procedure that can take place at a hospital, clinic, or infusion center.
There’s some risk of a serious allergic reaction. Your medical team will keep a close eye on you, particularly during the first infusion.
It’s not a one-time therapy. The infusion generally takes several hours. Your schedule might be once a week or once every two weeks in 28-day cycles.
The length of each infusion and the overall cycle of treatment depends on:
the specific combination of drugs you’ve been prescribed
whether you have severe side effects
your body’s response to therapy

What are the benefits and risks of monoclonal antibodies for myeloma?

What are the benefits and risks of monoclonal antibodies for myeloma?
When myeloma resists treatment or comes back after treatment, monoclonal antibodies give you another option. And having a specific target means it’s less toxic to healthy tissues than chemotherapy.
The downside of monoclonal antibodies is that they can cause side effects.
A severe allergic reaction can occur during treatment or within a few hours. Symptoms can include:
coughing, wheezing
trouble breathing
tightness in the throat
runny or stuffy nose
lightheadedness, dizziness
headache
rash
nausea
Side effects specific to Darsalex
Common side effects of Darzalex may include:
fatigue
nausea
back pain
fever
cough
lower blood cell counts, raising the risk of infection, bleeding, or bruising
Side effects specific to Sarclisa
The most common side effects of Sarclisa are:
respiratory infections such as colds or pneumonia
diarrhea
low white blood cell count, raising the risk of infection
low red blood cell count (anemia), causing weakness and tiredness
low blood platelets, raising the risk of bleeding and bruising
higher risk of developing a second cancer
Side effects specific to Empliciti
Common side effects of Empliciti include:
fatigue
fever
loss of appetite
diarrhea, constipation
cough
numbness and weakness in the hand and feet (peripheral neuropathy)
upper respiratory tract infections, pneumonia

How successful are monoclonal antibodies for myeloma?

How successful are monoclonal antibodies for myeloma?
Several novel therapies have come out in the last 20 years, and multiple myeloma outcomes have improved. Along with monoclonal antibodies, this includes:
immunomodulating agents
proteasome inhibitors
CAR T-cell therapy
Research suggests that monoclonal antibodies targeting CD-38 and SLAM F7, combined with other agents, have significantly extended outcomes. This includes people in all phases of multiple myeloma.
Monoclonal antibodies offer another form of therapy for those who:
are not eligible for stem cell transplant
have tried other therapies
have relapsed or refractory multiple myeloma

What other treatments may be used for myeloma?

What other treatments may be used for myeloma?
Your treatment plan will likely include a combination of therapies. And they may need some adjusting over time. Other drug treatments for multiple myeloma are:
chemotherapy
corticosteroids
immunomodulating agents
proteasome inhibitors
selinexor (Xpovio), a nuclear export inhibitor
teclistamab (Tecvayli), a bispecific T-cell engager (BiTE)
Other therapies include:
autologous stem cell transplantation
CAR T-cell therapy, a cell-based gene therapy
radiation therapy
supportive care

Takeaway

Takeaway
Monoclonal antibodies are a type of immunotherapy. In multiple myeloma, they target specific proteins on myeloma cells. This helps the immune system recognize the cancer cells and go on the attack.
Currently, there are three monoclonal antibody drugs for multiple myeloma. They’re typically used for those who have tried other therapies or are not eligible for stem cell transplant. They’re also useful in treating relapsed or refractory multiple myeloma.
Multiple myeloma is a complex condition that takes a personalized treatment plan. Your doctor can review the potential benefits and risks of each therapy so you can make the right choice for you.