The role of B-cell maturation antigen in the biology and management of, and as a potential therapeutic target in, multiple myeloma

E Sanchez, EJ Smith, MA Yashar, S Patil, M Li… - Targeted Oncology, 2018 - Springer
E Sanchez, EJ Smith, MA Yashar, S Patil, M Li, AL Porter, EJ Tanenbaum, RE Schlossberg…
Targeted Oncology, 2018Springer
B-cell maturation antigen (BCMA) was originally identified as a cell membrane receptor,
expressed exclusively on late stage B-cells and plasma cells (PCs). Investigations of BCMA
as a target for therapeutic intervention in multiple myeloma (MM) were initiated in 2007,
using cSG1 as a naked antibody (Ab) as well as an Ab–drug conjugate (ADC) targeting
BCMA, ultimately leading to ongoing clinical studies for previously treated MM patients.
Since then, multiple companies have developed anti-BCMA-directed ADCs. Additionally …
Abstract
B-cell maturation antigen (BCMA) was originally identified as a cell membrane receptor, expressed exclusively on late stage B-cells and plasma cells (PCs). Investigations of BCMA as a target for therapeutic intervention in multiple myeloma (MM) were initiated in 2007, using cSG1 as a naked antibody (Ab) as well as an Ab–drug conjugate (ADC) targeting BCMA, ultimately leading to ongoing clinical studies for previously treated MM patients. Since then, multiple companies have developed anti-BCMA-directed ADCs. Additionally, there are now three bispecific antibodies in development, which bind to both BCMA and CD3ε on T-cells. This latter binding results in T-cell recruitment and activation, causing target cell lysis. More recently, T-cells have been genetically engineered to recognize BCMA-expressing cells and, in 2013, the first report of anti-BCMA-chimeric antigen receptor T-cells showed that these killed MM cell lines and human MM xenografts in mice. BCMA is also solubilized in the blood (soluble BCMA [sBCMA]) and MM patients with progressive disease have significantly higher sBCMA levels than those responding to treatment. sBCMA circulating in the blood may limit the efficacy of these anti-BCMA-directed therapies. When sBCMA binds to B-cell activating factor (BAFF), BAFF is unable to perform its major biological function of inducing B-cell proliferation and differentiation into Ab-secreting PC. However, the use of γ-secretase inhibitors, which prevent shedding of BCMA from PCs, may improve the efficacy of these BCMA-directed therapies.
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