Unraveling the Potential of CAR T-Cell Therapy in Multiple Myeloma

Selecting Patients for CAR T-Cell Therapy

Dr. Sadashiv emphasizes the critical factors to consider when choosing patients for CAR T-cell therapy. In the past, CAR T was introduced earlier in the market for treating patients. Now, certain age limits have been pushed, and this therapy is found to be more well-tolerated compared to autologous transplant. Even for patients in their late 70s, with a relatively good performance status, age is no longer a barrier. However, for octogenarians, bispecifics are preferred as they are more tolerable. Elderly patients can also be considered for CAR T if they have a good performance status. Generally, younger patients or those with relatively few medical comorbidities are ideal candidates when considering CAR T treatment options.

Previously, CAR T was initially introduced at the fourth or fifth line of therapy, after multiple lines of treatment. The two drugs available in the market currently are idecabtagene vicleucel (Abecma) and ciltacabtagene autoleucel (Carvykti). But recent clinical trials, like KarMMa-3 (NCT03651128) for idecabtagene and CARTITUDE-4 (NCT04181827) for ciltacabtagene, have shown significant progress. Idecabtagene was approved after 2 lines of therapy, while CARTITUDE-4 looked at ciltacabtagene after 1 line of therapy. These studies demonstrate significant progression-free survival in earlier lines of therapy compared to the standard-of-care. This has led to the approval of these drugs for ciltacabtagene after the first line of therapy and for idecabtagene after the second line of therapy. It has expanded the usage of CAR T from the fourth or fifth line of treatment to now being considered in the second line after failure of transplant or for non-transplant candidates who fail their first line of treatment.

New Indications for CAR T-Cell Therapy

The new indications for CAR T-cell therapy in multiple myeloma are truly remarkable. It has opened up new avenues for treatment, providing hope to patients who previously had limited options. The ability to use CAR T at earlier lines of therapy, as demonstrated by the recent clinical trials, is a significant development. It shows the potential of this therapy to make a real impact on the disease progression and improve the quality of life for patients. The approval of these drugs in earlier lines of therapy is a game-changer and highlights the continuous evolution of CAR T-cell therapy in multiple myeloma.

Moreover, the fact that even elderly patients can be considered for CAR T, with proper evaluation of their performance status, is a major breakthrough. It shows that CAR T is not just limited to a specific age group but can be beneficial for a wide range of patients. This inclusivity is crucial in providing comprehensive treatment options and ensuring that no patient is left behind. The continuous exploration and expansion of indications for CAR T-cell therapy are paving the way for a more personalized and effective treatment approach in multiple myeloma.