Many Factors Influence Selection of CAR T Therapy, Bispecifics in Myeloma
The challenge of choosing and sequencing treatments for patients with relapsed/refractory multiple myeloma in the absence of extensive historical data requires experts to consider other factors, including adverse effects (AEs), and disease resistance mechanisms, and more, according to a presentation given by Ajai Chari, MD, during the 2023 SOHO Annual Meeting.
“It’s remarkable in phase 1 studies, where we’re never usually supposed to talk about efficacy, we’re now getting 60% to 100% response rates,” Chari, director of the Multiple Myeloma Program and a professor of clinical medicine at the University of California, San Francisco, said during the presentation. “We’re [also] seeing these amazing [figures regarding] progression-free survival [PFS] and duration of response [DOR]. The question is, ‘we have such great tools, how do we use them thoughtfully and sequentially?’
Available agents for relapsed/refractory multiple myeloma include CAR T-cell therapies and bispecific antibodies. Both classes of agent can target B-cell maturation antigens (BCMAs), and bispecific antibodies can also be directed towards G-protein–coupled receptor class 5 member D (GPRC5D), Fc receptor-homolog 5 (FcRH5), and CD3.
In terms of CAR T-cell therapy, in March 2021, idecabtagene vicleucel (ide-cel; Abecma) became the first BCMA-directed engineered tehrapy to be approved by the FDA for relapsed/refractory multiple myeloma. The agent is indicated for patients who had received at least 4 prior lines of therapy, including an immunomodulatory agent (IMiD), a proteasome inhibitor (PI), and an anti-CD38 monoclonal antibody. In February 2022, ciltacabtagene autoleucel (cilta-cel; Carvykti), also a BCMA-directed CAR T-cell therapy, was approved for the same patient population as ide-cel.
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