Exploring the Evolving Role of CAR T-Cell Therapies in Multiple Myeloma

Santhosh K. Sadashiv, MD, a hematologist with Allegheny Health Network and West Penn Hospital, and assistant professor at Drexel University School of Medicine, discusses the role of chimeric antigen receptor (CAR) T-cell therapy in patients with multiple myeloma.

Specifically, Sadashiv highlights what particular factors he considers most critical when selecting patients for CAR T-cell therapy. He also discusses some of the new indications for CAR T-cell therapy in multiple myeloma.

Transcription:

0:09 | It has changed a bit. Previously, CAR T was earlier to come on to the market for treatment of patients. So, we have pushed certain age limits, but this is much [more] well-tolerated compared [with] the autologous transplant. So, even [for] patients in their late 70's, and if they are doing well [with a] relatively good performance status, age is definitely not a barrier for these patients. But if they are really in their octogenarian status, then we would love to use, or prefer to use, bispecifics, which [are] much more tolerable.

0:55 | But even elderly patients can be considered for CAR T if they are deemed to be in a good performance status. But generally, younger patients or [those who are] otherwise fit with not too many medical comorbidities, would be an ideal candidate [when we are] considering CAR T treatment options.

1:16 | Previously, when they were initially introduced, they were introduced at the fourth- or fifth-line of therapy, again, relapsed to multiple lines of treatment. And that is where these treatments were initially approved, both [idecabtagene vicleucel (Abecma)] and [ciltacabtagene autoleucel (Carvykti)]. These are the 2 drugs that are available at present in the market. However, there were more recent clinical trials that were conducted, mainly KarMMa-3 [NCT03651128] for idecabtagene and CARTITUDE-4 [NCT04181827] for ciltacabtagene. The idecabtagene was earlier, after 2 lines of therapy, whereas CARTITUDE-4 looked at ciltacabtagene after 1 line of therapy.

2:03 | Both of these studies show significant progression-free survival in earlier lines of therapy compared [with] the standard-of-care. So, this led to the approval of these drugs, for the ciltacabtagene after the first-line of therapy, and for idecabtagene after the second-line of therapy. So, they have definitely moved from the space of fourth- or fifth-line of treatment to now second-line treatment after they have failed either their transplant or if they are initially being a non-transplant candidate for whatever reason after they fail their first-line of treatment, they cannot be considered for CAR T treatments.