Multiple myeloma patients are among the most vulnerable to Covid-19. Not only because if they are infected they have a greater risk of experiencing serious complications, especially pneumonia, but also because they often have to go to the hospital for checks and treatments. At the moment there is no therapy that can eradicate the disease and therefore cure it definitively, but in recent years important steps have been made to treat even the most difficult cases. The last of these was to identify a new ‘target’ on the surface of the diseased cells, in which it is possible to insert to hit them. Basically a ‘bug’, a ‘passage’ to be exploited. This is done by a ‘conjugated’ monoclonal antibody, that is, composed of two molecules: a humanized monoclonal antibody (belantamab) and an element (mafodotin) able to enter the cell to target a ‘key’ protein for disease development (BCMA, B cell maturation antigen). This new therapy, the first of its kind, has been shown in clinical studies to be able to control myeloma and increase survival in multi-treated patients, for whom no further therapeutic possibilities exist to date. In a few months it will also be available in Italy, where it is estimated that annually there are about 200 patients who will benefit immediately from the approximately 5000 new diagnoses of myeloma. But thanks to the European approval, the drug has also been included in the Expanded Access Program, which until approval by AIFA allows it to be used in particular clinical situations: thanks to this program, belantamab mafodotin it has already been provided free of charge by the manufacturing company to 49 Centers in 15 Regions to treat 70 patients who otherwise would have had no therapeutic alternative.
“In our Region every year 500 people get sick with multiple myeloma every year”, explains Felicetto Ferrara, Uoc Director of Hematology at the Cardarelli Hospital in Naples. “Of these, the great majority undergo recurrence of the disease and, for a not negligible percentage, the drug is more than a hope. In our hematology center, 170 patients / year are followed mainly in day-hospital treatment more advanced therapeutics, including autologous hematopoietic stem cell transplantation. Obviously the new drugs are considered as soon as possible, thanks also to the so-called EAP (expanded access program) that is made available by the pharmaceutical companies, before being placed on the market. it allows us to familiarize ourselves with the new drug and to be able to administer it in the optimal way once it is fully available. We are also involved in several clinical trials on new drugs in blood cancer diseases, including multiple myeloma. “
Treatment with belantamab mafodotin, which involves an intravenous infusion every 3 weeks, in the DREAMM-2 clinical trial achieved an overall response rate of 32%; more than half of the patients (58%) achieved an excellent partial or superior response, in some cases totally complete, and the median overall survival was about 14 months, almost tripled compared to the results currently achieved in clinical practice in same type of treatment. Important numbers, therefore, that open up new scenarios in the long challenge to multiple myeloma, not yet won but that we are able to fight with more and more weapons at our disposal.
“The indication for the use of this new molecule in heavily pretreated patients with relapsed or refractory multiple myeloma is an important milestone in our clinical practice. – adds prof. Ferrara –. The merit of this new ‘conjugated’ monoclonal antibody lies in the innovative mechanism of action directed towards BCMA, a protein expressed more importantly on the cell surface the more severe and advanced the myeloma “. In other words, the Belantamab monoclonal antibody binds to the cellular receptor of BCMA and prevents the proliferation of the tumor cell that needs the receptor / BCMA binding to survive. It should be added that BCMA is widely expressed in almost all myeloma cells, so it is possible to use Belantamab in all patients. Administration every 3 weeks represents a further undoubted advantage, especially in a period in which access to the hospital must be reduced to a minimum, especially for the elderly population. It should be remembered that in more than half of patients with multiple myeloma, the diagnosis is made at the age of over 70; in this fragile population, the reduction in hospital admissions acquires particular clinical significance.
“Belantamab – Professor Ferrara concludes- it allows us today to offer new hope to myeloma patients, to look to tomorrow and see the possibility of spending more time with their loved ones. The fight against cancer is made up of small daily steps, sometimes of sudden accelerations or of different strategies and approaches. In this case we have discovered where myeloma is most vulnerable and we have opened another front. For now we can treat a small part of the sick but I believe that future developments, including this drug, will open up new scenarios, certainly positive “with use in earlier stages of the disease.