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 Morsani College of Medicine at the University of South Florida, discusses the rationale for adding chimeric antigen receptor (CAR) T-cell therapy in earlier lines of therapy for relapsed/refractory (R/R) multiple myeloma.
FDA approvals for earlier use of idecabtagene vicleucel (Abecma; Ide-cel) and ciltacabtagene autoleucel (Carvykti; Cilta-cel) earlier this year allow the use of cilta-cel after one prior line and ide-cel after two prior lines. Shain says the demonstrated efficacy over standard of care supports earlier use, including at first relapse, and points out that the only difference between cilta-cel’s Phase 3 CARTITUDE-4 trial (NCT04181827) and ide-cel’s KarMMa-3 trial (NCT03651128) is line of therapy. He says that in patients who do not respond to lenalidomide (Revlimid), both should be considered.
Shain emphasizes that CAR-T cell therapies are highly effective in terms of disease-free interval, allowing patients to be treatment-free until the time of disease progression. He says this unique quality of life benefit of CAR-T cell therapy leads him to want patients to receive it as early as possible.
TRANSCRIPTION
0:08 | The new FDA approvals, the two randomized Phase 3 trials for ide-cel and cilta-cel, have shown that efficacy continues to be important in earlier lines of therapy as expected, maybe not quite as big a difference as we had previously expected. But I think KarMMa-3 was just one (further) line, so the difference was not that big. But it definitely shows that you can use these therapies safely and effectively in earlier lines of therapy. And they should be used in earlier lines of therapy and already at first relapse. I think in the context of (lenalidomide) refractory patients… it’s important for patients to look at other CAR-T products in that context.
0:54 | Again, (these are) very effective therapies with long-term disease-free and treatment-free intervals. I think that’s … the highlight, one of the things I find most fascinating and important about these therapies. … You’re doing therapy, and you don’t have to do therapy for long periods of time. And when you see the patients return to the clinic months after CAR T treatment with no disease and no therapy, for most of these people, that’s the most beautiful thing … ever … because it really has a profound impact on them. I think that’s what drives me to get these therapies to patients as quickly as possible.
