CAR T Cells Have Potential as Earlier-Line Therapy for Multiple Myeloma

Jesus G. Berdeja, MD, director of multiple myeloma research at Sarah Cannon Research Institute and hematology specialist at Tennessee Oncology, discusses the potential of chimeric antigen receptor (CAR) T-cell therapy to be approved for earlier lines of treatment in multiple myeloma.

Ciltacabtagene autoleucel (cilta-cel; Carvykti) and idecabtagene vicleucel (ide-cel; Abecma) have been approved for patients with relapsed/refractory multiple myeloma following 4 lines of therapy, including a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 antibody. Both of these CAR T-cell therapies have strong efficacy in this setting, and Berdeja says there are studies underway that could support earlier usage.

Additional trials such as the phase 2 KarMMA-2 trial (NCT03601078) of ide-cel and the phase 2 CARTITUDE-2 trial of cilta-cel (NCT04133636) are exploring treatment in patients who have received 1 to 3 lines of therapy. According to Berdeja, patients with high-risk disease could benefit greatly from CAR T-cell therapy early in the course of treatment, so CAR T-cell therapy could have a place as a frontline option.

Berdeja says that adopting these therapies is especially significant for certain populations that will not respond to alternative therapies. He also hopes that CAR T-cell therapy will be more readily available so patients with aggressive disease can receive it more easily.

TRANSCRIPTION:

0:08 | Right now, the commercial CAR Ts, both ide-cel and cilta-cel, are approved for patients who've had at least 4 prior lines of therapy—who have had a PI, an immunomodulatory agent, and an anti-CD38 antibody—so relatively late in the course of treatment. I think they'll have an immediate impact in the relapsed/refractory setting as they are now. But definitely studies are ongoing and trying to move these therapies earlier in the course of treatment.

0:36 | There are several studies, both KarMMA and CARTITUDE, ongoing in patients with 1 to 3 prior lines of therapy, comparing it to standard of care. There's actually a significant need in the high-risk population, even from the first line of therapy and there are actually studies ongoing in that high-need population even early on.

0:58 | But beyond that, there are actually now studies also looking at CAR T cells in the frontline setting. So, I think the future for CAR Ts is that these will be sort of implemented into the treatment paradigm of myeloma from the very beginning, and definitely in at least certain patient populations. And hopefully, they will be used better than where we are now, where oftentimes patients’ myeloma is so aggressive that they can't get to the CAR T cells. There is a potential that it could be used in every aspect of myeloma, again, depending on the availability and some of these logistical challenges.