Next-gen treatment keeps myeloma at bay for a year

Hundreds of people at fourth line in England and Wales could get a new lease of life thanks to a next-generation treatment shown to keep myeloma at bay for nearly a year.

A ground-breaking treatment, talquetamab (Talvey^®) can stop myeloma in its tracks for more than 11 months.

As it can be given fortnightly, it also offers more flexibility and respite between doses.

Up to 800 myeloma patients are expected to benefit from the new life-extending drug each year on the NHS in England and Wales.

Talquetamab is part of a new class of drugs, known as a bispecific antibody, which targets myeloma in a completely different way and helps overcome resistance to current treatments.

It is aimed at people who have received at least three previous treatments including an immunomodulatory agent such as lenalidomide (Revlimid^®), a proteosome inhibitor such as bortezomib (Velcade^®) and an anti-CD38 antibody like daratumumab (Darzalex^®).

Shelagh McKinlay, Director of Research and Advocacy at Myeloma UK, said:

“We’ve been making the case for this treatment to be approved for months and we couldn’t be happier to see it rolled out on the NHS in England and Wales.

Talquetamab offers more flexibility and leads to a better quality of life. Its unique mechanism of action means it can fight myeloma in a completely different way to other currently available bispecific treatments. This is key because, as people live longer with myeloma, they gradually become resistant to existing drugs.

This is a hard-earned victory for patients in England and Wales but there’s more work to be done and we will keep pushing for talquetamab to be approved in the rest of the UK. Until we have a cure, it is absolutely vital that people with myeloma are given as many options as possible to keep their disease under control, no matter where they live.”

Talquetamab helps the immune system to recognise and kill cancer cells by binding to both myeloma cells and T cells. T cells are a type of white blood cell in our immune system. When the bispecific antibody brings them into close contact with the myeloma cells, they are able to destroy these cells.

According to the latest trial data, almost 60% of patients on talquetamab had a very good partial response, or better.

Sue Harley, from Birmingham, was 54 when she was diagnosed with myeloma in 2017 after two years of increasingly debilitating back pain.

Her symptoms had initially been dismissed as osteoarthritis and old age and later misdiagnosed as metastatic breast cancer.

By the time her cancer was finally caught she had lesions in her spine and there was clear evidence of old rib fractures.

Over the next six years, the grandmother-of-two received five treatments, including DVT, DT-PACE, and CAR-T cell therapy, but none managed to keep her cancer at bay for long.

That is, until she was offered talquetamab through a compassionate use scheme in September 2023.

Two years on, Sue is still in remission – her longest to date – and credits the drug for giving her her life back.

“It has absolutely given me my life back,” said Sue, now 63. “This is my longest remission. I’d come very close to two years after CAR-T but I relapsed in 2023. I feel fit and healthy, I’ve run two half-marathons since I’ve been on talquetamab. I go to the gym, I go for lunch, I’m in two book groups and I volunteer for a charity once a week. I look after my grandchildren – they’re a joy.

“My granddaughter is five and she started school this year and my grandson is just over six months old. When I was diagnosed, I didn’t know if I would live to see grandchildren, let alone live to see them grow up.”

The mother-of-four added:

“It’s really good news. As patients all we want is to have options, to have a future ahead of us. This treatment is really manageable. It gives people a chance to live their lives, just like everybody else, to do normal things as well as exceptional things, if they want to.”

It all started back in 2015 when Sue began experiencing “extreme back pain”. She was initially told her pain was likely caused by osteoarthritis.

“It took two years before I was diagnosed,” she recalled. “I was back and forth to my GP with extreme back pain. They thought it was probably osteoarthritis but I had an X-ray which didn’t show anything. So they said it was likely age related. I had two lots of physio and I had acupuncture, but it made no difference. They never got to the bottom of it.”

Her lower back pain worsened to the point where she struggled to walk and she was so exhausted her friend once found her asleep in the local library.

“People were getting worried about me,” she said. “I could hardly walk and some days I couldn’t walk 10 steps. It was so difficult. There was an occasion where my friend found me asleep in the library. I kept going back to the GP thinking, this is not right. It was stopping me functioning and socialising.”

Things came to a head around Christmas 2016, when scans showed holes in her spine and healed rib fractures. She was wrongly diagnosed with metastatic breast cancer.

“They made a very definitive diagnosis which was all very shocking,” she added. “It had been nine years since I’d had breast cancer.”

But very quickly, doctors realised that the damage to her bones was not due to metastatic breast cancer but had in fact been caused by myeloma.

She was formally diagnosed with blood cancer in January 2017.

“I had never heard of myeloma,” she said. “The specialist said, it’s not curable but it’s treatable. So I came away from that appointment feeling positive, compared to having metastatic breast cancer.”

Over the next six years she went through five lines of treatment and even travelled to India to receive lenalidomide, which was not available on the NHS at the time.

When her cancer came back for the fifth time in 2023, she had run out of options.

That is until she was given talquetamab, a new promising drug not yet available on the NHS, through a compassionate use scheme.

“I’ve relapsed five times and it’s been difficult each time. For now, I feel like I can live my life like a normal person. This is my sixth line of treatment and there’s that hope that this is the thing that’s going to work for me forever. You can’t underestimate how important having hope is.”

What does this decision mean for people with myeloma?

The approval means eligible myeloma patients in England and Wales can now access to talquetamab on the NHS. It gives patients whose myeloma has become resistant to previous myeloma treatments access to an innovative treatment which targets myeloma cells in a new way.

Who can access talquetamab?

Patients at third relapse (also known as fourth line) and beyond who have previously been treated with an immunomodulatory drug, a proteosome inhibitor and an anti-CD38 monoclonal antibody can now receive talquetamab.

What is talquetamab?

Talquetamab is a new type of immunotherapy drug called a bispecific antibody. It works by helping your T cells (a type of immune cell) find and kill myeloma cells.

Talquetamab attaches to a protein found on the surface of myeloma cells called GPRC5D and a protein found on the surface of T cells called CD3, forming a link between myeloma cells and the T cell. It is the only available myeloma treatment that targets myeloma in this  way.

What about patients in Scotlandand Northern Ireland?

In Scotland, the Scottish Medicines Consortium (SMC) makes decisions about which treatments to fund through the NHS. We hope the SMC appraisal for talquetamab will start early next year.

In Northern Ireland, the Department for Health makes decisions on which treatments to fund through the NHS. It typically accepts the guidance issued by NICE, approving the use of the treatment shortly after publication of a positive final decision.

When will talquetamab be available on the NHS?

A positive recommendation from NICE means clinicians can start prescribing the treatment to eligible patients. However, it may take some time for the treatment to become available. This depends on the treatment and hospitals’ capacity to deliver it. However, the treatment should be made available to patients through the NHS within 90 days of the publication of the final decision.