CAR-T Meeting 2023 | Real-world experiences with ide-cel in R/R multiple myeloma
Doris Hansen, MD, Moffitt Cancer Center, Tampa, FL, discusses real-world experiences with idecabtagene vicleucel (ide-cel) for the treatment of patients with relapsed/refractory (R/R) multiple myeloma. Dr Hansen highlights the side effects observed in patients, as well as factors associated with an inferior progression-free survival (PFS), including prior exposure to BCMA-targeted therapies and high-risk cytogenetic features. This interview took place at the EBMT-EHA 5th European CAR T-cell Meeting held in Rotterdam, The Netherlands.
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Transcript (edited for clarity)
We’ve just looked at real-world experience with idecabtagene vicleucel or ide-cel, as you may have seen. So what we have seen is that the majority of patients did benefit from this therapy. Outside of the confines of a clinical trial, we saw that 75% of the patients would have been ineligible. Common reason for ineligibility would have been things like cytopenias, organ dysfunction, like renal insufficiency, as well as prior exposure to BCMA-targeted therapy and a poor ECOG performance status...
We’ve just looked at real-world experience with idecabtagene vicleucel or ide-cel, as you may have seen. So what we have seen is that the majority of patients did benefit from this therapy. Outside of the confines of a clinical trial, we saw that 75% of the patients would have been ineligible. Common reason for ineligibility would have been things like cytopenias, organ dysfunction, like renal insufficiency, as well as prior exposure to BCMA-targeted therapy and a poor ECOG performance status.
We did identify that patients had a similar safety profile or side effect profile. For example, rates of cytokine release syndrome, neurologic toxicity are very similar. We did see higher grade of cytopenias at day 30 or beyond in our ide-cel population requiring a higher TPO mimetic use, and numerically higher, at least, stem cell boost for management of cytopenias.
We also identified some factors that were associated with inferior progression-free survival, specifically prior exposure to BCMA-targeted therapy, high-risk cytogenetics, which we define by the presence of translocation 4;14, 14;16, deletion 17p. Poor ECOG performance status of two or higher at lymphodepletion as well as younger age did result in inferior progression-free survival.
Our follow-up was short, it was 6.1 months, but we did see the median PFS to be very similar to the clinical trial. In terms of the responses, our response rates were more similar to the KarMMA clinical trial, the cohort of patients that received a higher CAR-T cell dose or 450 million or so, which was more similar to the cell dose patients receive in the real-world setting. We did see our best overall response rate to be 84% and our complete response or better to be about 40%, which was again, as I mentioned, similar to that higher dose cohort. So these patients do benefit regardless of whether they would have met inclusion criteria for the trial. Regarding cilta-cel, we don’t have this information yet, but I’m happy to report this has been submitted to ASCO and will be embargoed until then. But we’ll look forward to hopefully presenting those results for you guys soon.
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