Thread by @End_myeloma

@jmikhaelmd @BonumCe @JanssenUS @pfizer 2/ 🎇🆓 AMA PRA Credit 🎇
CME ℹ️ & ref list👉 bit.ly/3DtOjtZ
🗝️ Disclosure info 👇
#BonumCE #MMSM

@jmikhaelmd @BonumCe @JanssenUS @pfizer 3/🛫Taking off...
🤔#biomarker definitions
🎯Dx biomarkers distinguish👥w disease &👥 w/o
🔮Prognostic biomarkers forecast likelihood of a clin event, dz progression or recurrence
🔮Predictive biomarkers identify 👥 more likely to experience favorable/unfavorable effect from 💊💉

@jmikhaelmd @BonumCe @JanssenUS @pfizer 4/ 📊 #BonumCE #MMSM

SP is 63 yo/M presents w anemia & bone pain
BMBX shows 70% clonal plasma cells and FISH reveals t(11;14)
MRI shows multifocal bone lesions
sBCMA is 227 ng/mL and SLAMF7 8.3 ng/mL by ELISA

☑️ Which is diagnostic of #multiplemyeloma in SP❓

@jmikhaelmd @BonumCe @JanssenUS @pfizer 5/ ✅If you picked MRI with >1 lesion 🙌!
#MultipleMyeloma-defining biomarker by @IMFmyeloma IMWG 👉 SLiM 🦀

“S”= 60% clonal bone marrow plasma cells
“Li”= 🆓light chain ratio >100%
“M”=MRI w/ >1 lesion
“C”=calcium
“R”=renal insufficiency
“A”=anemia
“B”=bone lesions

@jmikhaelmd @BonumCe @JanssenUS @pfizer @IMFmyeloma 6/ There are many biomarkers 🎯 for diagnostic & prognostic use in #multiplemyeloma
Predictive biomarkers for response to a specified 💉💊 have not been established
☀️Good 📰!
🧑🏻‍🔬 are 🔬 #BCMA as a predictive #biomarker

#BonumCE #MMSM

@jmikhaelmd @BonumCe @JanssenUS @pfizer @IMFmyeloma 7/ ⬆️ sBCMA above median correlated w/ ⬇️ PFS & ⬇️OS in pts w/ #multiplemyleoma
Correlation 🔎 in ND & RRMM
sBCMA maintained independent prognostic value after adjustment for:
✍️renal function
✍️age
✍️serum β2 microglobulin
✍️hemoglobin
✍️bone disease

#BonumCE #MMSM

@jmikhaelmd @BonumCe @JanssenUS @pfizer @IMFmyeloma 8/ ⬆️ baseline sBCMA in 👥MGUS & SMM are predictive of progres.➡️ #multiplemyeloma
📈 MGUS PFS HR 3.44 for sBCMA ≥77 vs <77ng/mL
📈SMM PFS HR 2.0 for sBCMA ≥128 vs <128ng/mL
✍️Effect of sBCMA on PFS was maintained when adjusting for baseline MGUS or SMM risk

#BonumCE #MMSM

@jmikhaelmd @BonumCe @JanssenUS @pfizer @IMFmyeloma 9/ Normalization of sBCMA may:
🔮 OS for 👥receiving tx
🔮 a⬆️likelihood of response

👥 who began tx w baseline sBCMA levels in normal range had a ⬆️ PFS & OS relative to 👥 w⬆️ baseline sBCMA
👥 who had ⬆️baseline sBCMA whose sBCMA normalized during tx had ⬆️OS
#BonumCE #MMSM

@jmikhaelmd @BonumCe @JanssenUS @pfizer @IMFmyeloma 10/ 📊 #BonumCE #MMSM
☑️Which of the following biomarker-treatment pairs is a POTENTIAL predictive #biomarker in #MultipleMyeloma❓

@jmikhaelmd @BonumCe @JanssenUS @pfizer @IMFmyeloma 11/ ✅If you picked BCMA - belantamab 👏!
High baseline soluble BCMA correlated w reduced belantamab mafodotin minimum drug exposure concentration @ the end of 21-day dosing interval in ppl w #multiplemyeloma

#BonumCE #MMSM

@jmikhaelmd @BonumCe @JanssenUS @pfizer @IMFmyeloma 12/ 📍Other therapies & sBCMA:
🚗Several studies show that response, PFS, & OS after BCMA-directed CAR T-cell tx in MM are not assoc w baseline BCMA levels on tumor cells

🚗Other CAR-T trials show pretreatment BCMA levels have impact on depth or durability of response
#BonumCE

@jmikhaelmd @BonumCe @JanssenUS @pfizer @IMFmyeloma 13/ 🔎 Discrepancies between 🚗 CAR-T studies may be explained in part by
1️⃣ Differences in assays used to quantify BCMA expression (flow cytometry > sensitive than IHC)
2️⃣ Measurement of membrane-bound BCMA vs. soluble BCMA (sBCMA)

#BonumCE #MMSM

@jmikhaelmd @BonumCe @JanssenUS @pfizer @IMFmyeloma 14/ 💎Phase 1⃣ study of SQ elranatamab
▶️(investigational #BCMA targeting bispecific antibody)

👉 free soluble BCMA ⬇️ w/ ⬆️ doses
👉& demonstrated sustained ⬇️throughout each dose interval
#BonumCE #MMSM

@jmikhaelmd @BonumCe @JanssenUS @pfizer @IMFmyeloma 15/ 🤔 sBCMA = prognostic, ≠ predictive
sBCMA 📉 w/ response to BCMA & non-BCMA bispecific abs in R/R #multiplemyeloma
🤔Phase 1 studies → responders have ⬇️ in sBCMA (88%-teclistamab & 98%-talquetamab)
🤔Non-responders have ⬆️ sBCMA (80%-teclistamab & 49%-talquetamab)
#BonumCE

@jmikhaelmd @BonumCe @JanssenUS @pfizer @IMFmyeloma 16/ 📊 #BonumCE #mmsm

🔊Have your say...

☑️Which best represents your use of sBCMA #biomarker assay❓

@jmikhaelmd @BonumCe @JanssenUS @pfizer @IMFmyeloma 17/ #BonumCE #mmsm
🎀 Wrap Up Summary 🎀
✍️ Multiple diagnostic & prognostic biomarkers are routinely used
🙅 No predictive biomarkers are #FDA approved
✍️ Accumulating 📉 supports sBCMA as a biomarker
✍️ Guidelines 🙅 do not currently recommend routine testing for sBCMA

@jmikhaelmd @BonumCe @JanssenUS @pfizer @IMFmyeloma 18/ Thank you 🙏 for joining this #MMSM #tweetorial w me, @jmikhaelmd & @BonumCe
🌟Want your 🆓 CME?🌟
Click here 👉 bit.ly/3tVNwPi ✅

🚨👇Answer our post-test polls!

@jmikhaelmd @BonumCe @JanssenUS @pfizer @IMFmyeloma 19/ #BonumCE #mmsm

🚨Posttest Q 1️⃣
📊 Which is a #MultipleMyeloma-defining diagnostic biomarker by the IMWG?

@jmikhaelmd @BonumCe @JanssenUS @pfizer @IMFmyeloma 20/ #BonumCE #mmsm

🚨 Posttest Q 2️⃣
📊 Which biomarker-treatment pairs is a POTENTIAL predictive #biomarker in #MultipleMyeloma?

@jmikhaelmd @BonumCe @JanssenUS @pfizer @IMFmyeloma 21/ #BonumCE #mmsm

🚨Posttest Q3️⃣
📊 Which best represents your use of sBCMA biomarker assay?

@jmikhaelmd @BonumCe @JanssenUS @pfizer @IMFmyeloma 22/ 💫 U didn't know this was part of a series of #MultipleMyeloma #CME?
Don’t fret #hemonc #OncTwitter 💕
🆓 #CME 🏆 credit
#BonumCE

#MedTweetorial w @jmikhaelmd & @SurbhiSidanaMD

https://twitter.com/jmikhaelmd/status/1486862790677520386

@jmikhaelmd @BonumCe @JanssenUS @pfizer @IMFmyeloma @SurbhiSidanaMD 23/ 🛑 There's MORE! 🛑

#MedTweetorial on MOAs of BCMA-directed therapies in #MultipleMyeloma
w @ninashah33 & @SurbhiSidanaMD

https://twitter.com/ninashah33/status/1489399841817960451?s=20&t=nDL12lTVwZdSWTJ8StdtcA

@jmikhaelmd @BonumCe @JanssenUS @pfizer @IMFmyeloma @SurbhiSidanaMD @ninashah33 24/ #BonumCE
Hope you’re not 🥱 tired yet, there’s also 2 broadcasts for #MMSM learning 🎉
1️⃣ Efficacy of BCMA-directed therapies

👇🎥Broadcast on Efficacy of Approved/Emerg #BMCA-dir Tx in #MultipleMyeloma w @jmikhaelmd @ninashah33 @SurbhiSidanaMD

https://twitter.com/jmikhaelmd/status/1506390384074629120

@jmikhaelmd @BonumCe @JanssenUS @pfizer @IMFmyeloma @SurbhiSidanaMD @ninashah33 25/ #BonumCE #mmsm
I promise, we’re almost done!

👇🎥 Broadcast: Anticipating & Managing Toxicity in BMCA-dir Tx #MultipleMyeloma 🎬
w @jmikhaelmd @ninashah33 & me

https://twitter.com/jmikhaelmd/status/1508945910314663936

@jmikhaelmd @BonumCe @JanssenUS @pfizer @IMFmyeloma @SurbhiSidanaMD @ninashah33 26/ Thanks again for joining!
Follow @BonumCe for more 🆓 #CME on Twitter!