Теклистамаб в терапии множественной миеломы: обзор литературы и первое клиническое применение препарата в России

The modern paradigm for the treatment of hematologic tumors can hardly be imagined without immunotherapy including the most rapidly developing group of drugs referred to as bispecific antibodies. Teclistamab is a humanized bispecific antibody created for targeted impact on the B-cell maturation antigen (BCMA) expressed in multiple myeloma and CD3 receptor located on the surface of T-lymphocytes. BCMA is a transmembrane protein, a member of the tumor necrosis factor receptor superfamily. It is essential for the survival of plasma cells and is characterized by minimal expression on non-hematopoietic cells. Currently, there are three main BCMA-targeting treatment approaches having unique advantages and certain restrictions. Antibody-drug conjugates (ADC) show moderate efficacy as monotherapy and high efficacy in combination with other drugs in relapsed/refractory multiple myeloma (r/r MM), but their use is limited by ocular toxicity. The therapy with chimeric antigen receptors (CAR) of T-cells is considered the most promising approach, which, however, is not free of substantial logistic and economic restrictions. Bispecific antibodies, on the other hand, show high efficacy and acceptable toxicity profile compared to ADC, although their long-term administration poses a cumulative risk for infectious complications. This paper provides a literature review and reports the first experience in administration of teclistamab, a bispecific antibody drug, as a monoregimen in a r/r MM female patient with triple refractoriness to the previous treatment.