Exploring the Key Takeaways from the CARTITUDE-2 Trial in Multiple Myeloma

Mounzer Agha, MD, director of the Mario Lemieux Center for Blood Cancers at UPMC Hillman Cancer Center and the clinical director of the Hematopoietic Stem Cell Transplantation of UPMC, discusses the phase 2 CARTITUDE-2 trial (NCT04133636) looking at ciltacabtagene autoleucel (cilta-cel) in patients with multiple myeloma.

Agha says that the key takeaway from CARTITUDE-2 is that B-cell maturation antigen chimeric antigen receptor (CAR) T-cell therapy is extremely effective in patients with multiple myeloma. This trial demonstrated it can be used safely in this population. The adverse event profile of cilta-cel, including neurotoxicity and cytokine release syndrome (CRS), was manageable. The majority of patients who experienced CRS had grade 1 or 2 toxicity and most had quick resolution of this event.

The movement and neurocognitive events observed in CARTITUDE-1 (NCT03548207) were not encountered in CARTITUDE-2 because the risk factors were identified by the investigators, according to Agha. They started a mitigation strategy which allowed options such as a bridge in therapy and aggressive treatment of CRS. By doing so, neurocognitive and movement toxicities were less likely.

Cilta-cel has shown to be an effective and safe therapy for patients with multiple myeloma in earlier treatment settings. Agha feels this represents a paradigm shift in the treatment of multiple myeloma, and patients will not have to progress on multiple other therapies before receiving CAR T-cell therapy. Five years from now, he is confident CAR T will be a first-line therapy.