Is Elotuzumab Monotherapy Beneficial in Patients With Smoldering Multiple Myeloma?
Posted: Friday, July 6, 2018
Monotherapy with elotuzumab, an immunostimulatory immunoglobulin G1 monoclonal antibody, demonstrated minimal activity in patients with high-risk smoldering multiple myeloma, in a recent phase II study. The findings of the study, led by Sundar Jagannath, MD, of The Tisch Cancer Institute, Mount Sinai Medical Center, New York, were published in the British Journal of Haematology.
Elotuzumab works by directly activating natural killer (NK) cells and mediating antibody-dependent cellular cytotoxicity, leading to targeted myeloma cell death. Investigators found no association, however, between baseline proportion of CD56dim NK cells in bone marrow and maximal change in serum monoclonal protein, a marker of disease, in response to elotuzumab therapy.
The study enrolled 31 patients with high-risk smoldering multiple myeloma to receive elotuzumab at 10 mg/kg (n = 16) or 20 mg/kg (n = 15) in 28-day cycles. The overall response rate was 10%, and the rate of progression-free survival at 2 years was 69%. At a minimum follow-up of 28 months, 5 patients in each treatment arm had progressed to active multiple myeloma.
Elotuzumab was generally well tolerated, with a safety profile similar to that observed in previous studies. The most common adverse event reported was upper respiratory tract infection, occurring in 58% of patients. Grade 3 or 4 adverse events were reported 13 patients (42%).
Despite limited effectiveness with elotuzumab as monotherapy, studies combining the agent with lenalidomide and dexamethasone in patients with high-risk smoldering multiple myeloma are currently under way.