IMS 2025: Elranatamab Consolidation After Ide-Cel Shows Promise in Relapsed or Refractory Multiple Myeloma

In an interview with Pharmacy Times®, Matthew Lei, PharmD, BCOP, clinical pharmacy specialist from Massachusetts General Hospital, discussed findings from a phase 2 trial evaluating elranatamab (elran) as consolidative therapy after idecabtagene vicleucel (ide-cel) in patients with relapsed or refractory multiple myeloma (RRMM). He highlighted his poster, "PA-051 Initial Results of a Phase 2 Study to Evaluate Elran Post-Ide-Cel Consolidation (EPIC) in Patients with RRMM," which he shared at the 22nd annual International Myeloma Society (IMS) meeting and exposition in Toronto, Canada.

Lei noted that while ide-cel produces strong initial responses, durability remains limited with a median progression-free survival of about 12 months. Early results from 16 patients showed that elranatamab improved response rates, including higher rates of stringent CR, VGPR, and MRD negativity. He emphasized that the strategy leverages sequential use of CAR-T cells and T-cell engagers to enhance response and prolong outcomes.

Pharmacy Times: Can you start by introducing yourself?

Matthew Lei, PharmD, BCOP: Hi, my name is Matthew Lei. I'm a clinical pharmacy specialist at Massachusetts General Hospital. I'm here at IMS 2025 presenting our poster, which was a study evaluating elranatamab post-ide-cel as consolidative therapy for patients with relapsed/refractory multiple myeloma.

Pharmacy Times: Can you briefly summarize the EPIC trial and why consolidation with elranatamab after idecabtagene vicleucel was chosen for patients with relapsed/refractory multiple myeloma?

Lei: In this phase 2 trial, the intent was to utilize consolidative therapy post-standard care ide-cel. From the KarMMa and KarMMa-3 trials, we know that although the majority of patients respond, these responses are not durable. The median PFS is approximately 12 months or a little over 12 months. The goal is to deepen response, with the aim of improving progression-free survival.

Pharmacy Times: What were the key efficacy signals observed in these initial phase 2 results?

Lei: Our initial results from 16 patients have shown that consolidation with elranatamab does improve response rates. We observed an increase in stringent CR and VGPR rates and also increases in MRD negativity with this strategy.

Pharmacy Times: How does elranatamab’s mechanism of action complement or differ from ide-cel?

Lei: We know that there are specific mechanisms of resistance with CAR-T cells and T-cell engagers. Some are overlapping, and some are not. The goal is to combine these strategies sequentially, with the aim of reinvigorating CAR-T activity. This way, we gain activity from both the T-cell engager and the CAR-T cell, hopefully improving response and durability.

The approach is based both on mechanism and sequencing. Data show that sequential T-cell engager therapy, or T-cell engager therapy prior to CAR-T, is inferior compared to CAR-T followed by sequential T-cell engagers. This strategy leverages those insights to improve response and PFS.