Expert: CAR T-Cell Therapies Improve Outcomes for Patients With Multiple Myeloma

In an interview with Pharmacy Times at the American Society of Clinical Oncology (ASCO) 2022 Annual Meeting, Yi Lin, MD, PhD, discussed her presentation about new CAR T-cell therapies and how they are changing the treatment landscape for multiple myeloma.

How are CAR T therapies used in multiple myeloma?

Yi Lin, MD, PhD: Sure, absolutely. So, as of about this time last year, March 2021, we have the first FDA-approved CAR T to treat patients with relapsed/refractory multiple myeloma. And by the end of February this year, we have a second CAR T also approved. So, both products are approved for myeloma patients who have had 4 prior lines of treatment and have been treated with, really, the 3 major backbones of myeloma treatment, which is the proteasome inhibitor, immunomodulatory drug, and CD38 antibody. So that's the approved indication. And then, of course, we have lots of clinical trials, looking at both the approved CAR Ts in the earlier line setting, including frontline and then other innovative CAR T strategies.

Why is there a need for new CAR T therapies?

Yi Lin, MD, PhD: Sure, I think multiple myeloma is a disease that does respond well to immune-based treatment, and that's proven by the fact that, as I mentioned, the backbone of the treatment includes immunomodulatory drugs and monoclonal antibody that's really used from first line treatment all the way through relapsed refractory settings. So, CAR T is very exciting, as another platform or modality of treatment, if you will, that's really using patients’ own immune cells and using it as a one-time treatment, the way it's approved right now, as a way to gain remission in treatment. And so, I think the opportunity for CAR T is, how can we work with this living drug that will to continue to prolong the remission, maybe even start to think about the word cure, while minimizing some of the side effects that we can see with other types of treatments.

Cilta-Cel is one of the newest approved CAR T therapies for this patient population. Can you discuss this specific approval?

Yi Lin, MD, PhD: Sure. So ciltacabtagene autoleucel, or cilta-cel, brand name is Carvykti, is the new BCMA-targeting CAR T that's approved this year. And the CAR construct that's used here is what's unique about this particular CAR T—it targets 2 different areas of BCMA, as opposed to a lot of other different CAR T strategies that may only target 1 region. It's prescribed on a weight-based dose that generally is on the lower side of those that needed to treat this disease and it has a very impressive clinical response. So, in the registration study, the patients enrolled generally were very late lines and medium lines of therapy with 6 prior treatments coming onto the study. And we saw in this patient population that 98% of the patients had a response and 83% of those patients had deep responses, stringent [complete response], and now we have more than 2 years of follow up and the median progression free survival and median overall survival haven't been reached yet on that study. The 2-year PFS rate is close to 60%. So, this is very impressive clinical response for a one-time treatment with no maintenance follow up in this disease space.