Functional High-Risk is a Leading Rationale for Early CAR T in Myeloma

EP: 1.Patient Selection Factors for Earlier Use of CAR T-Cell Therapy

EP: 2.Earlier CAR T-Cell Therapy Benefits Functional High-Risk Group in RRMM

EP: 3.Efficacy of Cilta-Cel Is Maintained in Early Relapsed Multiple Myeloma

EP: 4.Functional High Risk and Bridging in Multiple Myeloma Considered With CAR T Cells

Samer A. Al’Hadidi, MD, assistant professor in the Department of Internal Medicine — Division of Hematology and Oncology at UAMS Winthrop P. Rockefeller Cancer Institute in Little Rock, Arkansas, discusses factors influencing early use of chimeric antigen receptor (CAR) T-cell therapy in patients with relapsed/refractory multiple myeloma.

At a Case-Based Roundtable event, Al’Hadidi moderated a discussion on when to use ciltacabtagene autoleucel (cilta-cel; Carvykti) now that it has been approved in the second line. He said other oncologists reported concerns about using it early vs using it after multiple relapses when it has been established to work well and other therapies are no longer effective.

According to Al’Hadidi, one subset where CAR T-cell therapy is most relevant is in functional high-risk patients who have relapsed rapidly after autologous stem cell transplant (ASCT) and would benefit most from immediate access to CAR T-cell therapy. They also discussed how in other patients, triplet regimens including agents that patients are not yet refractory to, such anti-CD38 monoclonal antibodies, are reasonable to use first while preparing to give CAR T cells later.

They also brought up long-term adverse events (AEs) of CAR T-cell therapy, which are a learning process for hematologists in the community setting who care for patients after they have been treated in an academic center. It is important to counsel patients on these AEs, so they know what to expect.

TRANSCRIPTION:

0:10 | We also discussed when to consider CAR T-cell therapy as a second line, because there is some concern about using CAR T-cell therapy early on due to the fact that we know it works in a later line. Should we just use it early or keep it for later? There was some discussions on what we can base our decision on based on patient factors and disease factors.

One of the major themes that we discussed is the fact that there is a subset of patients called functionally high-risk patients, where they relapse quickly after ASCT. In this subset of patients, the access to CAR T-cell therapy is extremely important because they may benefit from using it early on. But we also discussed the fact that using other treatments, triplet-based regimens, specifically for patients who are anti-CD38 naive or exposed but not refractory, is very reasonable while we prepare the patients for the possibility of doing CAR T cells in the future.

1:11 | We also discussed long-term AEs that we need to watch for, and in the CAR T space, some of that is still a learning process for us and what we need to watch for for the long term, and how those discussions in the clinic can be done with patients.