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COMy 2025 | The importance of developing next-generation CAR constructs
Binod Dhakal, MD, Medical College of Wisconsin, Milwaukee, WI, comments on the need for next-generation CAR products in multiple myeloma (MM), noting the transformative impact of CAR T-cell therapy on the treatment landscape while highlighting the limitations and unmet needs in specific patient populations. Dr Dhakal emphasizes the importance of addressing safety concerns, manufacturing time, and the lack of a cure for myeloma, suggesting that developing next-generation CAR products is necessary to overcome these challenges. This interview took place at the 11th World Congress on Controversies in Multiple Myeloma (COMy) congress in Paris, France.
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Transcript
CAR-T has changed the treatment landscape of multiple myeloma. It has been very transformative and patients have done very well with the CAR-T treatment. Having said that, there is still a certain unmet area or unmet group of patients who have not derived the same significant benefit as other patients. For example, patients with high-risk disease, patients with extramedullary disease, patients who are much older, patients with comorbidities, they probably haven’t derived the same benefit...
CAR-T has changed the treatment landscape of multiple myeloma. It has been very transformative and patients have done very well with the CAR-T treatment. Having said that, there is still a certain unmet area or unmet group of patients who have not derived the same significant benefit as other patients. For example, patients with high-risk disease, patients with extramedullary disease, patients who are much older, patients with comorbidities, they probably haven’t derived the same benefit. Particularly, the patients with the high-risk disease are something, you know, they do respond but the response doesn’t last that long – number one.
Number two, the safety of the CAR-T is still a concern because of the CRS and ICANS, though we are better at managing it, it still can happen, especially in patients with a higher disease burden. The current manufacturing time is also a problem because, especially, you have a higher disease burden, patients rapidly relapsing, have no time to wait. You can’t wait for six weeks for that. So, I think because of that.
And lastly, CAR is still not a cure in myeloma. You know, you have prolonged responses, durable responses for a large number of patients, but still not cured. There’s no plateau yet. So, I think multiple reasons that we need to have a better CAR, we need to have a next-generation CAR, something that you can give safely and also very, very effective, potentially curative potential. And lastly, can also overcome this logistical challenge of manufacturing and the wait time and all those things.
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