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      Antibody–drug conjugate, GSK2857916, in relapsed/refractory multiple myeloma: an update on safety and efficacy from dose expansion phase I study

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          Abstract

          Interim analyses of a phase I study with GSK2857916, an antibody–drug conjugate against B cell maturation antigen, have previously reported a 60% overall response and 7.9 months progression-free survival in relapsed/refractory multiple myeloma (MM). We provide updated safety and efficacy results of the BMA117159 trial following an additional 14 months' follow-up. This open-label, first-in-human, phase I study was conducted at nine centres in the USA, Canada and the UK, and included adults with MM and progressive disease after stem cell transplantation, alkylators, proteasome inhibitors, and immunomodulators. In part 1, the recommended dose of 3.4 mg/kg was identified; in part 2, patients received GSK2857916 3.4 mg/kg once every 3 weeks. Selected part 2 safety/tolerability and efficacy endpoints are reported. Twenty-one (60.0%; 95% confidence interval (CI) 42.1–76.1) of 35 patients achieved partial response or better, including two stringent complete responses and three complete responses. The median progression-free survival was 12 months and median duration of response was 14.3 months. Thrombocytopenia and corneal events were commonly reported; no new safety signals were identified. GSK2857916 was well tolerated and demonstrated a rapid, deep and durable response in heavily pre-treated patients with relapsed/refractory MM, consolidating the interim analyses conclusions that GSK2857916 is a promising treatment for these patients.

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          Targeting CD38 with Daratumumab Monotherapy in Multiple Myeloma.

          Multiple myeloma cells uniformly overexpress CD38. We studied daratumumab, a CD38-targeting, human IgG1κ monoclonal antibody, in a phase 1-2 trial involving patients with relapsed myeloma or relapsed myeloma that was refractory to two or more prior lines of therapy.
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            BCMA Is Essential for the Survival of Long-lived Bone Marrow Plasma Cells

            Long-lived humoral immunity is manifested by the ability of bone marrow plasma cells (PCs) to survive for extended periods of time. Recent studies have underscored the importance of BLyS and APRIL as factors that can support the survival of B lineage lymphocytes. We show that BLyS can sustain PC survival in vitro, and this survival can be further enhanced by interleukin 6. Selective up-regulation of Mcl-1 in PCs by BLyS suggests that this α-apoptotic gene product may play an important role in PC survival. Blockade of BLyS, via transmembrane activator and cyclophilin ligand interactor–immunoglobulin treatment, inhibited PC survival in vitro and in vivo. Heightened expression of B cell maturation antigen (BCMA), and lowered expression of transmembrane activator and cyclophilin ligand interactor and BAFF receptor in PCs relative to resting B cells suggests a vital role of BCMA in PC survival. Affirmation of the importance of BCMA in PC survival was provided by studies in BCMA−/− mice in which the survival of long-lived bone marrow PCs was impaired compared with wild-type controls. These findings offer new insights into the molecular basis for the long-term survival of PCs.
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              Multiple myeloma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†

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                Author and article information

                Contributors
                +1-416-946-4566 , Suzanne.Trudel@uhn.ca
                Journal
                Blood Cancer J
                Blood Cancer J
                Blood Cancer Journal
                Nature Publishing Group UK (London )
                2044-5385
                20 March 2019
                20 March 2019
                April 2019
                : 9
                : 4
                : 37
                Affiliations
                [1 ]ISNI 0000 0001 2150 066X, GRID grid.415224.4, Princess Margaret Cancer Centre, ; Toronto, ON Canada
                [2 ]ISNI 0000 0001 2171 9952, GRID grid.51462.34, Department of Medicine, Myeloma Service, , Memorial Sloan Kettering Cancer Center, ; New York, NY USA
                [3 ]ISNI 000000041936877X, GRID grid.5386.8, Department of Medicine, , Weill Medical College of Cornell University, ; New York, NY USA
                [4 ]ISNI 0000 0004 0581 2008, GRID grid.451052.7, NIHR/University College London Hospital Clinical Research Facility, , NHS Foundation Trust, ; London, UK
                [5 ]Levine Cancer Institute, Atrium Health, Charlotte, NC USA
                [6 ]ISNI 0000 0001 1034 1720, GRID grid.410711.2, Lineberger Comprehensive Cancer Center, , University of North Carolina, ; Chapel Hill, NC USA
                [7 ]ISNI 0000000122986657, GRID grid.34477.33, University of Washington, ; Seattle, WA USA
                [8 ]ISNI 0000 0001 2106 9910, GRID grid.65499.37, Dana-Farber Cancer Institute, ; Boston, MA USA
                [9 ]ISNI 0000 0004 0393 4335, GRID grid.418019.5, GSK, ; Philadelphia, PA USA
                [10 ]ISNI 0000 0004 1936 8972, GRID grid.25879.31, Abramson Cancer Center, , University of Pennsylvania, ; Philadelphia, PA USA
                Article
                196
                10.1038/s41408-019-0196-6
                6426965
                30894515
                1e6d59e9-98f1-4f9a-b743-adf993a8da5b
                © The Author(s) 2019

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 31 December 2018
                : 15 February 2019
                : 25 February 2019
                Funding
                Funded by: FundRef https://doi.org/10.13039/100004330, GlaxoSmithKline (GlaxoSmithKline plc.);
                Categories
                Article
                Custom metadata
                © The Author(s) 2019

                Oncology & Radiotherapy
                Oncology & Radiotherapy

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