Referral for CAR T Should Always Be Considered in R/R Multiple Myeloma
Kenneth Shain, MD, PhD, discusses why he recommends most patients with relapsed/refractory multiple myeloma be referred for evaluation to receive chimeric antigen receptor T-cell therapy.
Kenneth Shain, MD, PhD, associate member in the Malignant Hematology program and director of the Myeloma Research Center at Moffitt Cancer Center, and assistant professor at the University of South Florida Morsani College of Medicine, discusses why he recommends most patients with relapsed/refractory (R/R) multiple myeloma be referred for evaluation to receive chimeric antigen receptor (CAR) T-cell therapy.
Shain says that CAR T-cell therapy is sometimes thought of as an intensive therapy, but it is generally well tolerated besides some toxicities that must be monitored. He notes that unlike hematopoietic stem cell transplant, there is no age limit of 75 years on the use of CAR T cells. At Moffitt Cancer Center, they give it to patients who are over the age of 80, sometimes preferring idecabtagene vicleucel (Abecma; ide-cel) over ciltacabtagene autoleucel (Carvykti; cilta-cel) in the older population based on relative risk of neurological toxicity.
He adds that although there are always some patients who aren’t appropriate for therapy, virtually anyone can be considered, but some patients are not referred to a specialist which keeps them from being treated. Since the efficacy and treatment-free interval of CAR T-cell therapy are superior to any other therapy available, it should always be considered, since the benefits outweigh the risks, provided patients are well educated and monitored for toxicities.
TRANSCRIPTION
0:10 | It really is a therapy that's well tolerated across broad strokes of what myeloma is. A lot of people think of it as really intensive therapy, and even some of my comments before may have suggested that. But we don't have an age limit. This is not like [stem cell] transplant. We don't cut people off at 75, which at least is our cutoff here at Moffitt. We do CAR [T-cell therapy] in people [who] are over 80. In fact, we lean towards a little bit more ide-cel in people who are a little bit more senior, just because they have less grade 3 neurological toxicities. But this is a therapy for everybody. There are not a lot of people who aren't CAR T candidates. It's just getting folks to us.
0:52 | My story again goes back to getting patients to us, understanding this is a therapy that is for almost anybody—there are always people [who] are maybe not perfect candidates, but for anybody—and the power of it is the efficacy tied with the drug-free or treatment-free intervals that occur after are pretty amazing for our patients. So it's just education on the pros and cons, and the pros do outweigh the cons. The cons have to be respected. We're always going to understand that and continue to respect that and treat those and monitor our patients and educate them about what can happen.
FDA Accepts BLA for Belantamab Mafodotin Combinations in R/R Multiple Myeloma
November 25th 2024The FDA has accepted the BLA for belantamab mafodotin in combination with bortezomib and dexamethasone, or pomalidomide and dexamethasone, in relapsed/refractory multiple myeloma, as supported by DREAMM-7 and DREAMM-8 data.
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