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Elotuzumab: a novel anti-CS1 monoclonal antibody for the treatment of multiple myeloma

Introduction: While conventional therapies are associated with high response rates in patients with newly diagnosed multiple myeloma, the development of drug resistance remains an issue, and effective therapy for relapsed and refractory patients represents a major clinical unmet need. Areas covered: We reviewed the published data regarding the development and clinical investigation of a CS1-targeted monoclonal antibody, elotuzumab, for the potential treatment of multiple myeloma. Preclinical pharmacological data, along with clinical efficacy, safety, and tolerability of elotuzumab alone and in combination, are summarized. Expert opinion: Elotuzumab, in combination with lenalidomide, demonstrated a remarkably high overall response rate in Phase I and II studies. Additionally, the improvements observed in progression-free survival suggested important superiority over lenalidomide/dexamethasone alone, with a similar tolerability profile. While elotuzumab is associated with a higher incidence of infusion reactions, these can be effectively mitigated with appropriate premedication. The high activity of the elotuzumab/lenalidomide combination is now being further investigated in randomized Phase III trials. Elotuzumab represents an exciting future potential treatment option for patients with multiple myeloma, including those with relapsed and refractory disease, as well as in the induction and post-transplant maintenance settings, and possibly even for early therapy in patients with high-risk smoldering myeloma.