What is Immunotherapy for Multiple Myeloma? Understanding Its Role in Treatment

Dr. Joseph Mikhael: Peel this baby  off. What is immunotherapy for myeloma? Today we're going to talk about the most searched  questions in myeloma and specifically the most   searched questions about immunotherapy. The  first question is, well, "Does immunotherapy   work for myeloma?" Yes. Next question. I guess  I should give a bit more detail. All right,   so it does. To remind ourselves, immunotherapy  is the concept of us employing a patient's own   immune system to fight their myeloma. Now this is  a little bit of irony in myeloma because remember   myeloma is a cancer of the immune system, but the  whole immune system is not affected by myeloma.   Parts of it remain intact. The intact parts  are what we use to help fight myeloma. This,   as we've learned, is much better than  just using external drugs as it were,   or other treatments because your immune system  is an incredible device and works in incredible   ways. We know it's reliable because it's  in you and this way it can attack myeloma. So next one here. It says, "Well, how  does immunotherapy fight cancer?" Well,   this is where we started using immunotherapy in  cancer, and now as I describe, I think myeloma's   a perfect example of how we can use it. You can  think of it this way. We harness the strength of   the immune system now to attack someone's cancer  so that the machinery that's built to attack,   let's say an infection that you might get or some  kind of insult to your body, your immune system   is designed to fight it and to protect you.  That's what the immune system concept is. So,   now we can turn the tables a little bit  and use it to fight that part of you that   we don't like, which is cancer. That's how  we started in the field of immunotherapy,   starting with cancer and of course working in  multiple cancers including multiple myeloma. All right, next question is, "When is immune  therapy used for myeloma?" Well, I've been around   the block long enough to remember the days when  we treated myeloma with old school chemotherapy,   the bald and barf unfortunately kind of  chemotherapy where we just gave big doses   of chemo to patients. But now that has really  evolved in what we're doing. Now we use forms   of immunotherapy right from the very first time  we treat someone with myeloma throughout their   whole myeloma treatments and their whole myeloma  career as it were. Immunotherapy is not just a   boutique little area that's used once or twice. We  use it throughout the whole spectrum of myeloma. All right, next question. "Is immunotherapy  covered by insurance?" Hopefully it's covered   as much as this tape, but it is covered  because the immunotherapies we use are   now part of the natural treatments of  multiple myeloma. Sometimes of course,   like with all insurance coverage, we  need to get special authorization and   pre-authorization and those kinds of things. But  in general, those immunotherapies that are now   approved by the FDA, of which we have many, are  indeed covered so people can have access to them. "What are the types of immune therapies?"  There is a lot of complexity here but let me   simplify it and say there are really three major  categories of immune therapies. Number one, what   we call monoclonal antibodies, so these are drugs  that mimic our own antibodies that we make. If I   get a flu shot, I make antibodies to the flu to  protect me. Well now we give someone an antibody   that hooks onto the myeloma and triggers the  immune system to destroy it. Number two is what   we call CAR-T-cell therapy or chimeric antigen  receptor T-cell therapy. I know it's a mouthful,   but the bottom line here is now we take from a  patient what are called T-cells. These are like   soldier cells, they're part of our immune  cells. We take them out of the patient,   and we manufacture them and manipulate them  in such a way that they're going to recognize   a patient's tumor, a patient's cancer.  We multiply them in the lab and then we   give them back to patients to attack their  myeloma. That's called CAR-T-cell therapy. Then the third type is what we call bispecific  antibodies. Bispecific antibodies are drugs,   kind of like their name says, bi meaning they  have two arms. One arm hook onto the myeloma,   the other arm hooks onto a local  T-cell and engages that T-cell or   activates it to immediately attack the multiple  myeloma. This sounds like a Star Trek movie,   but this is what we're doing for  patients with multiple myeloma. All right, we got two questions left.  "List immunotherapy drugs available." Well,   there are lots of them, as I said, in those  three categories. So for monoclonal antibodies,   Darzalex, also known as daratumumab, Sarclisa,  also known as isatuximab, and elotuzumab,   also known as Empliciti. Right now, we have  two CAR-T-cell therapies approved in multiple   myeloma. One is called Ide-cel or Abecma,  and one is called cilta-cel or Carvykti. We have three types of bispecific antibodies.  One's called teclistumab or Tecvayli. One's   called talquetamab or Talvey. The  third one is elranatamab or Elrexfio. All right, we're coming up to the last one  here. Drum roll please. "Can immunotherapy   cure cancer?" Well, that's what we all want.  That's the ultimate goal. I think we have moved   closer to curing multiple cancers, including  myeloma, with immunotherapy than we ever did   with our other treatments. This looks to the  future of what we're doing. I talked about   monoclonal antibodies and CAR-T-cell therapy  and bispecific antibodies. Well, we're making   newer and better forms of those, and I'm excited  about what we're able to do with immunotherapy. Hopefully this has been helpful to you as  we think a little bit about immunotherapy. I   think I have another board somewhere. Oh,  Sapna. Thank you, thank you, thank you. If this has been helpful to you, but you want to  ask more questions, in lots of different ways.   You can call the phone number at the IMF. You  can email the info line. You can follow us on   social media, I do a lot of Facebook Lives. You  can follow us on Instagram, on X. You can use the   hashtag #AsktheIMF and we'll make sure we get an  answer from you. Of course, there's a time to be   in person. Join us at our events. If you're helped  by these things and you want to help others, feel   free of course to support us as well. Well, that's  it for me. Thanks so much for joining me today.