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Lesson 7,
Topic 1
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Comparison of outcomes with elranatamab and real world treatments in the UK for triple class exposed relapsed and refractory multiple myeloma
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Daily Literature Update
Comparison of outcomes with elranatamab and real world treatments in the UK for triple class exposed relapsed and refractory multiple myeloma
Tsang C, O’Reilly JE, Carpenter L, et al. BMC Cancer. 2025;25(1):1219. PMID: 40713551.
Introduction
Patients with triple class exposed relapsed/refractory multiple myeloma (TCE RRMM) have limited treatment options and poor outcomes. Elranatamab is a novel bispecific BCMA antibody showing promising efficacy.
Study Type: Retrospective observational external control arm
Population: 123 elranatamab patients (MagnetisMM-3) and 81 UK real-world TCE RRMM patients
Intervention: Elranatamab monotherapy vs 13 different real-world regimens
Outcomes: Progression-Free Survival (PFS) and Overall Survival (OS)
Key Findings
- Real-world median PFS: 3.71 months; OS: 11.00 months
- Elranatamab median PFS: not reached; OS: not reached at 15 months
- Unadjusted elranatamab PFS benefit: dRMST +6.95 months (95% CI 4.08–9.61)
- Adjusted PFS benefit sustained: dRMST +6.45 months; OS benefit equivocal post-adjustment
Context & Related Research
- Tsang et al., 2025: PFS benefit in UK cohort; OS results not statistically significant (PMID:40713551), reinforcing current study findings.
- Tomasson et al., 2024: Demonstrated long-term safety and survival outcomes with elranatamab in MagnetisMM-3 (PMID:39055646).
- Mohty et al., 2024: Patient-reported outcomes and symptomatic PFS improvements (PMID:38420657).
- Costa et al., 2024 & 2025: US real-world ECAs support PFS benefit and OS trends (PMIDs:38415370; 40491859).
- Mol et al., 2024/2025: MAIC analyses favor elranatamab over teclistamab and physician’s choice (PMIDs: 40190254; 38347747).
- Peery et al., 2025: BCMA-directed immunotherapies overview abstracts context and usage (PMID:39373355).
- Encinas et al., 2025; Gordan et al., 2025: Economic analyses provide cost-effectiveness context (PMIDs:40193043; 40495704).
Clinical Implications
- Elranatamab offers superior progression-free survival compared to standard UK treatments in TCE RRMM.
- Consideration for elranatamab incorporation into treatment algorithms is warranted, aligning with updated NICE recommendations.
- Ongoing surveillance of overall survival and real-world safety remains important.
Strengths & Limitations
| Strengths | Limitations |
|---|---|
| Multi-center NHS real-world data with granular patient level information | High missing data for key prognostic variables (ISS, ECOG) |
| IPTW and sensitivity analyses to mitigate confounding bias | Residual unmeasured confounding possible, including cytogenetic risk |
| Use of biochemical progression proxies aligning with IMWG PFS definitions | Immature overall survival data limits definitive conclusions |
Future Directions
Randomized direct comparative trials and longer follow-up in real-world cohorts are necessary to validate and extend survival and safety findings for elranatamab in TCE RRMM.
Elranatamab significantly prolongs progression-free survival compared to standard real-world therapies in UK patients with triple class exposed relapsed and refractory multiple myeloma.
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