One of the most anticipated drug classes for the treatment of multiple myeloma (MM) comprises therapies that target B-cell maturation antigen (BCMA).
Multiple myeloma treatment
Unlike most of the currently available treatment regimens that have to be administered in doublet or triplet combinations to provide clinical efficacy, anti-BCMA biologics have demonstrated striking efficacy as monotherapies in heavily pretreated MM patients.
Key opinion leaders interviewed by GlobalData are highly optimistic about these therapies and agree that they will be paradigm-changing. Anti-BCMA agents are addressing a significant unmet need in MM, as they are effective in patients who have progressed on multiple therapies including immunomodulatory drugs, proteasome inhibitors, and anti-CD38 antibodies such as Darzalex (daratumumab), which is being increasingly adopted in all treatment lines in MM.
GlobalData’s research identified four anti-BCMA biologics that are leading the clinical development race in this class of therapy.
Among these, Bluebird Bio and Celgene’s chimeric antigen receptor therapy (CART) bb2121 and GlaxoSmithKline’s antibody-drug conjugate GSK2857916 are expected to be launched in 2020, which will be followed by the 2021 launches of two other therapies: Johnson & Johnson and Legend Biotech’s CART JNJ-68284528, and Amgen’s bispecific T-cell engager (BITE) antibody AMG420.
GlobalData anticipates the total revenues from these four therapies to be approximately $10 billion, which will make up 35% of total MM drug revenues in 2027 in the eight major markets (US, France, Germany, Italy, Spain, UK, Japan, and China).
Annual revenues of the four therapies following their launches in 2020–2027
As these therapies are entering the MM market around the same time and are all positioned for the treatment of heavily pretreated patients, competition for market share seems inevitable.
The deeper remission rates and one-time administration make CAR-T therapies an attractive treatment option. On the other hand, the specific toxicities associated with their use may render them more suitable for younger and fit patients who still have an intact immune system. In addition, high treatment cost and long preparation times for CAR-T therapies are other factors that will impact their adoption in the clinic.
AMG420 and GSK2857916 will have the cost advantage over the CAR-T therapies, which is likely to facilitate market access. These more conventional therapies may be more suitable for elderly and frail patients as the treatment could be initiated much faster compared to CAR-T therapies and the treatment could be adjusted easily based on the adverse events that the patient is experiencing. While all four therapies are targeting the same molecule, it is the details of their mechanisms of action, administration, and cost that will determine their place in MM treatment.
GlobalData (2019). Multiple Myeloma – Global Drug Forecast and Market Analysis to 2027, yet to be published