CAR T-Cell Therapy for Early-Relapsed Multiple Myeloma

This content originally appeared on our sister site, OncLive®.

While progress is being made in multiple myeloma treatments and strategies, unmet needs remain for patients with high-risk disease, poor prognostic factors, and relapsed disease.

“Things are changing in multiple myeloma, and it is definitely becoming more of a chronic disease. However, there are certain patient groups that we need to pay particular attention to, and those would be the high-risk patients that still have a poor survival,” said Faith E. Davies, MD, a professor in the Department of Medicine and director of the Clinical Myeloma Program at NYU Langone Health’s Perlmutter Cancer Center. “Also, we need to learn how to embrace many of the new therapies that are being developed, and particularly, learn how to manage their adverse effects [AEs] so that we can better utilize them with our patients.”

The 2021 Institutional Perspectives in Cancer webinar on multiple myeloma focused on up-front and relapsed/refractory updates in the disease, as well as how to approach patients with high-risk myeloma. In an interview with OncLive®, Davies discussed the latter, as well as how CAR T-cell therapies fit best for that patient population.

OncLive®: There are several therapeutic options for patients with relapsed/refractory myeloma. How do you choose what is best for someone with early relapsed disease?

Davies: When we are thinking about treating patients with early relapsed multiple myeloma, we need to [consider] a whole host of factors. The first one would be how well [the patient] did with their initial therapy and exactly what that treatment was, so that we can decide whether we need to stay with the same class of drugs or change it. We also need to think about the adverse effects [AEs] that the patient may have [experienced] with their initial therapy so that we can ideally try to avoid those AEs moving forward.

Finally, we need to think about comorbidities, because many patients may have aged a little since we started their initial therapy, and therefore, we need to think [more] about cardiac and neuropathy issues, diabetes, etc., so we can get a handle on which drug classes we should be including in our combinations.

One of the talks during the program focused on CAR T-cell therapy in patients with multiple myeloma. What promise has this modality demonstrated in the early relapse setting?

For CAR T cells, most of the studies have been performed in patients with relapsed/refractory disease. The data in that patient group—where in the past we have always been surprised if patients have a response or if they have a long remission—have shown that there is a high response rate, that there is a high number of patients achieving minimal residual disease negativity, and that many of those patients can have a prolonged disease-free period.

[There are] certainly a number of AEs associated with [CAR T-cell] therapy, which need some management, but it shows a lot of promise. The promise may actually be earlier in the disease course, because if you think that the kinds of results we are seeing in patients who have previously had 10 lines of therapy, imagine what kind of results we might get in patients who are at their first relapse, for instance. Many of the clinical studies that are being undertaken now are looking at [CAR T-cell therapy in] earlier lines of therapy, or indeed, looking at those high-risk patients who may be in their first line of therapy. We are looking to see whether CAR T-cell therapy may be appropriate for them.

Transcript edited for clarity.