ASH 2023 | Cilta-cel vs ide-cel for R/R multiple myeloma: making the decision in clinical practice
Noffar Bar, MD, Yale School of Medicine, New Haven, CT, discusses the factors clinicians should consider when choosing between ciltacabtagene autoleucel (cilta-cel) and idecabtagene vicleucel (ide-cel) for treating patients with relapsed/refractory (R/R) multiple myeloma (MM). Although the likelihood of achieving a deep response is higher with cilta-cel, availability poses a challenge in providing this CAR-T product to every patient. Dr Bar highlights that some patients will achieve an equal depth of response with ide-cel; however, identifying these individuals is not possible at present. This interview took place at the 65th ASH Annual Meeting and Exposition, held in San Diego, CA.
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Transcript (edited for clarity)
You know, I think there are a lot of factors in choosing cilta-cel versus ide-cel. In an ideal world, you know, based on the complete response rates we see with cilta-cel -duration of response, progression-free survival -I’d rather do cilta-cel. Does that mean that some patients who get ide-cel might actually respond just as well but the chance of that deep response is lower, right? So I think to figure out which patients might do just as well with ide-cel, that’s an unanswered question...
You know, I think there are a lot of factors in choosing cilta-cel versus ide-cel. In an ideal world, you know, based on the complete response rates we see with cilta-cel -duration of response, progression-free survival -I’d rather do cilta-cel. Does that mean that some patients who get ide-cel might actually respond just as well but the chance of that deep response is lower, right? So I think to figure out which patients might do just as well with ide-cel, that’s an unanswered question. I think that’s very interesting because right now, a lot of the limiting factors also in choosing is availability. So, what is available for the patient? Also, what’s the aggressive nature of the disease? Do I have a long time to wait? Do I have bridging therapy for them? If I only have ide-cel available for me in the short term, is that more likely for me to get that patient to get a CAR-T? I do find that patients with less aggressive disease, less kinetically active disease, might do fine with ide-cel. So I think that’s, you know, really an unanswered question: which patients particularly might do just as well with ide-cel? I really see this when I talk to my patients. What is the chance they will get into this deep response? Well, the chances are higher with cilta-cel. So, if I had to choose, I would choose cilta-cel if I had the ability.
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