Consider Efficacy, Safety, Convenience, Cost for Myeloma Treatments


With multiple therapies available for patients with myeloma, there are some considerations that patients should discuss with their clinicians before choosing which one is right for them, an expert said.

When choosing similar treatment options for multiple myeloma — such as Elrexfio (elranatamab-bcmm) and Tecvayli (teclistamab-cqyv), which both target the BCMA protein on cancer cells — patients and their clinicians should consider efficacy, safety, convenience and cost, explained Dr. Ajai Chari.

Chari, who is a professor of medicine and the director of Clinical Research in the Multiple Myeloma program and associate director of clinical research at Mount Sinai Cancer Center Clinical Trials Office, recently discussed the two drugs in an interview with CURE®.

“It's great for patients and payers to have choices, and you don't have to take the one drug that is available. So this will drive down the price, I think over time, and that's great for patients to have more choices,” Chari said.


Well, how do we distinguish (Elrexfio [elranatamab-bcmm]) to (Tecvayli [teclistamab-cqyv]), because if they're both by specifics targeting BCMA, what's the difference?

I think when I compare products in my mind as a physician, I think about efficacy, safety, convenience and cost. Those are the four variables that might make drugs different. One thing we're always taught in medical school is to not do cross-study comparisons. We're always tempted to say, “Let's compare drug A to B,” but they were in separate studies, (in) separate populations. There may be differences, and it's not really appropriate to compare them directly, because if one is 70%, the other 65% that is just “potato, po-tah-to.” And if you did a larger study they may be (similar).

With that caveat, then I don't think there's a big difference in efficacy, and I don't think there's going to be a big difference in safety. (Regarding) convenience, it may be slightly different. Some drugs are given weekly, some are every other week, some are IV, some are subcutaneous shots.

But I think the biggest difference will be cost. And this is great for myeloma patients … if you think about one of the most commonly prescribed medications being statins; everybody's heard of Lipitor (atorvastatin) and Crestor (rosuvastatin), but there's about 10 of them. Maybe I stopped keeping track. One of the things that it does is drive down the price. It's great for patients and payers to have choices, and you don't have to take the one drug that is available. This will drive down the price over time, and that's great for patients to have more choices.

But from an efficacy safety perspective, I don't think there's going to be major differences. Personally, I think it's really going to be about some nuances about convenience and cost. Certainly, we can eventually get to giving by specifics more as an outpatient. That would be a big part of it. Plus, under convenience, if even more conveniently and community centers have been blessed, but right now they're pretty comparable if you're targeting the same target.

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