Moving Forward in Multiple Myeloma: Earlier Lines of CAR-T Cell Therapy

Dr. Debu Tripathy, Professor of Medicine Chair, Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center.

An innovative and groundbreaking cancer treatment has been made available earlier to patients with multiple myeloma, as chimeric antigen receptor (CAR)-T cell therapy is propelled ever closer to the front line of treatment.

In this special issue of CURE, we spotlight the use of CAR-T cell therapy in recent years to treat multiple myeloma, a cancer of the plasma cells — a type of immune cell that produces antibodies. CAR-T cell therapy involves extracting, modifying and reinfusing a patient’s own T cells, a type of immune cell, to specifically recognize and attack cancer cells.

“Cancers of the immune system often know all the tricks of the immune system and are able to bypass them,” Dr. Rahul Banerjee, assistant professor in the division of hematology and oncology at the University of Washington and assistant professor in the clinical research division at the Fred Hutch Cancer Center, both in Seattle, told CURE. “With CAR-T, you level the playing field.”

The first Food and Drug Administration (FDA) approval of a CAR-T cell therapy to treat multiple myeloma, Abecma (idecabtagene vicleucel),came in 2021, followed by Carvykti (ciltacabtagene autoleucel) in 2022. Both were approved for patients who had received at least four prior lines of treatment, but earlier this year, the FDA approved Abecma for patients who had received two prior lines of therapy and Carvykti for patients who had received one prior line of treatment. Successful treatments are often eventually tested at earlier stages of therapy, although

safety and toxicities are important factors in sorting out the optimal sequence of deployment.

We spoke with experts about current clinical trials evaluating CAR-T cell therapy in even earlier lines of therapy as well as developments in treatment strategies. We also discuss the challenges,

side effects and potential of these treatments as they currently exist.

“I would say [for] CAR-T cells in general, not just for myeloma but for all cancers, we’re in the same place as we were for stem cell transplantation back in the ’70s and early ’80s,” Dr. Saad Usmani, chief of myeloma service at Memorial Sloan Kettering Cancer Center in New York City, said.

“We have a long way to go. And I think we’ll be able to develop very effective therapies using this technology in the future.”

DEBU TRIPATHY, M.D.

EDITOR-IN-CHIEF

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