CAR-T Meeting 2022 | Approved and emerging CAR-Ts in multiple myeloma
Hermann Einsele, MD, FRCP, University of Würzburg, Würzburg, Germany, comments on the efficacy and safety of idecabtagene vicleucel (ide-cel) and ciltacabtagene autoleucel (cilta-cel), two chimeric antigen receptor T-cell (CAR-T) therapies for multiple myeloma. Ide-cel has been approved by the FDA and EMA for patients with multiple myeloma who have received at least three lines of prior therapy and has shown impressive results in terms of overall response rate (ORR) and progression-free survival (PFS), with a low incidence of cytokine release syndrome (CRS) and neurotoxicity. Cilta-cel is another promising CAR-T therapy for multiple myeloma. Although it hasn’t been approved yet, studies are reporting very high response rates (RR) and remarkable PFS data, with limited toxicities. Clinical trials are also investigating these CAR-T therapies in earlier lines of therapy, which could ultimately allow achieving long-term control of the disease. This interview took place at the EBMT-EHA 4th European CAR T-cell Meeting which was held virtually in 2022.
Transcript (edited for clarity)
So there’s one product, ide-cel, Abecma, which has been already approved by the FDA and the EMA, and is already available as a commercial product in the US and in Europe, at least in France and in Germany. Several patients have been treated. It’s mainly considered in patients with three lines of prior therapy, at least in Europe, and progressing after the last line. In these patients, we see an overall response rate of about 82%, complete remission beyond 30%, and a progression-free survival at the highest dose level of around 11...
So there’s one product, ide-cel, Abecma, which has been already approved by the FDA and the EMA, and is already available as a commercial product in the US and in Europe, at least in France and in Germany. Several patients have been treated. It’s mainly considered in patients with three lines of prior therapy, at least in Europe, and progressing after the last line. In these patients, we see an overall response rate of about 82%, complete remission beyond 30%, and a progression-free survival at the highest dose level of around 11.3 months with progression-free survival of nearly two years in patients that achieve complete remission. So in these heavily pre-treated patients, a very impressive treatment result. And in addition, the toxicity of this treatment, when compared to CD19-directed CAR-T therapy in ALL and in lymphoma, it’s much better. So we have a low incidence of grade 3 neurotoxicity and grade 3 CRS. So between 3% and 5%. So very tolerable and actually in some of the US centers, they already think about giving CAR-T therapy for myeloma in the outpatient setting.
In addition, there are other products coming to the market. One product, cilta-cel is probably going to be approved this year or early next year. And the update was reported at the last ASH meeting and also here at the European CAR T-cell Meeting. And the response rate is 97%, the overall response rate beyond 80%, and the median progression-free survival beyond two years. So again, a really impressive treatment result, again with limited toxicities.
So I think CAR-T therapy is really a new option for patients with advanced-stage multiple myeloma. And in addition, we see CAR-T therapy moving to earlier lines of therapy. There have been several trials reported in which CAR-T therapy is given for first relapse or following one to three prior lines of therapy. Also in this setting where obviously the CAR-Ts are fitter and maybe, persist for a longer time period, and also the toxicity was really very acceptable. So a very good option also for earlier lines of therapy. And I think if we aim for long-term disease control with CAR-Ts, we’ll definitely have to position CAR-T therapy in earlier lines of therapy.
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