Available CAR T-Cell Therapies in Multiple Myeloma

Adam D. Cohen, MD, associate professor of medicine at the Hospital of the University of Pennsylvania, discusses the different chimeric antigen receptor (CAR) T-cell therapies used for multiple myeloma treatment and delves into their potential benefits and risks.

The 2 FDA-approved CAR T-cell therapies available include idecabtagene vicleucel (ide-cel; Abraxane) and ciltacabtagene autoleucel (cilta-cel; Carvykti).

Cohen discussed this topic during the Fifth Annual Miami Cancer Institute Global Summit on Immunotherapies for Hematologic Malignancies, hosted by Dr. Guenther Koehne and Miami Cancer Institute.

Transcription:

0:09 | For CAR T cells, [there are] 2 that are available. One is called ide-cel and 1 is cilta-cel. These are both BCMA-directed CAR T-cell products. [We] have to do apheresis to collect T cells from the patient. There is a manufacturing process that can last several weeks, and then you re-infuse those into the patient after lymphodepleting chemotherapy. These are currently approved after 4 more prior lines of therapy. That includes a CD38 antibody, proteasome inhibitor, and [immunomodulatory drug]. In the United States, it is 3 prior lines. As I mentioned, we are all hoping that those might be moving a little bit earlier based on some of those phase 3 trials coming out.

0:46 | I think 1 of the big benefits is that it is a 1 and done treatment that [we] infuse into the patient. The CAR T cells are sort of like a living drug that is made from the patient's own cells that can persist for months, and try to eliminate residual disease. Patients get a break from treatment, which is something they have not had in many years once they have had relapsed/refractory myeloma.

1:09 | In addition, these are potent. They have high response rates, anywhere from 73% for ide-cel up to 98% for cilta-cel, and some of these responses can be very durable, even 4 years in some patients. Now, the risks of CAR T cells are well described. They include acute risks like cytokine release syndrome and neurologic toxicity, then later risks that can include infections, cytopenias, low blood counts, and in some cases, some rare toxicities such as a Parkinson-like neurotoxicity as well as secondary malignancies. Certainly, [we] have to counsel patients about all these risks, [we] have to monitor them closely, but all the data suggests the benefits definitely seem to outweigh these risks.