Survival May Not Differ by Race in Multiple Myeloma Treated With Abecma

There were no racial or ethnic differences between patients with regards to overall survival (the time a patient lives following treatment) or progression-free survival (the time a patient lives following treatment without their disease spreading or becoming worse) when treated with the standard-of-care CAR-T cell therapy Abecma (idecabtagene vicleucel, also referred to as ide-cel), according to recent study findings.

These findings are despite the fact that patients with multiple myeloma face racial disparities regarding diagnosis, with the disease having been shown to be twice as common among Black patients than White patients.

Pooling data from 207 patients with relapsed/refractory multiple myeloma — 22 of whom (11%) were Hispanic, 36 of whom (17%) were non-Hispanic Black and 149 of whom (72%) were Non-Hispanic White — at a median follow-up of 9.3 months, researchers found that non-Hispanic Black patients had comparatively higher median levels of C-reactive protein and baseline ferritin (both markers of inflammation) and were more likely to develop cytokine release syndrome (a systemic inflammatory response). Meanwhile, best overall response rate (patients whose cancer shrinks or disappears as a result of treatment) was lower for Hispanic patients.

“Despite differences in safety and response to (Abecma), our findings encourage the use of (Abecma) in all (relapsed/refractory multiple myeloma) patients,” researchers wrote in the study published in Blood Advances.

Researchers stated that there were “no statistically significant differences” in progression-free survival or overall survival by race and ethnicity. The median progression-free survival was 4.2 months for Hispanic patients, 6.5 months for Non-Hispanic Black patients and 8.5 months for Non-Hispanic White patients.

The median overall survival across all racial and ethnic groups was not yet reached, meaning more than half of the patients in each racial and ethnic group were still alive.

In light of the findings of this study, which was purported to be the first investigation of clinical outcomes of Abecma by race and ethnicity, researchers called for the data to be confirmed among “larger samples of diverse (relapsed/refractory multiple myeloma) patients with longer follow-up time.”

One caveat noted by researchers was the fact that these data are from patients with multiple myeloma who have access to and received treatment with Abecma.

“While access to CAR-T cell therapy for (relapsed/refractory multiple myeloma) has improved over time, treatment with CAR-T cell therapy is only approved at certain academic centers with limited availability in the community setting. … Recent studies also show that racial and ethnic minority (relapsed/refractory multiple myeloma) patients are underrepresented in the use of CAR-T cell therapy in both the clinical trial and commercial setting. Some data suggest that socioeconomic status and insurance coverage contribute to the low representation of racial and ethnic minority (relapsed/refractory multiple myeloma) patients in CAR-T cell therapy clinical trials. However, additional research is critically needed to evaluate additional barriers to access to CAR T-cell therapy so that all patients can derive benefit from novel advancements in the management of (relapsed/refractory multiple myeloma).”

Those findings are consistent with what Dr. Brandon Blue, a clinical instructor in the department of malignant hematology at Moffitt Cancer Center in Florida, told CURE® earlier this year: when it comes to factors impacting patients with multiple myeloma, important questions persist.

“We're still trying to decide, is this a nature versus a nurture issue? … Because then, we need to figure out, once we can answer that, how to direct our efforts,” said Blue. “Meaning that if we know that there are certain biological differences then we can actually find targets (to) change the natural course of some of the more aggressive biology types. Or, if we say, ‘Hey, this is really not a biological issue. This is more of a social construct,’ then let's focus our attention there, to help with what they call the social determinants of health and make sure that those things are leading to equal access.”

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