Peter Voorhees, MD and Louis Williams, MD discuss how CAR T-cell therapy eligibility assessment, optimal timing for earlier-line treatment, long-term efficacy data from CARTITUDE studies, and emerging next-generation CAR T products are reshaping the treatment landscape for relapsed/refractory multiple myeloma patients.
Panelists discuss how approximately 75% to 80% of patients with multiple myeloma are eligible for chimeric antigen receptor (CAR) T-cell therapy at some point during their care, with eligibility determined by safety criteria including organ function and comorbidities, logistical feasibility, and efficacy considerations rather than direct comparisons to autologous transplant.
Panelists discuss how chimeric antigen receptor (CAR) T-cell therapy is increasingly being used earlier in the treatment paradigm rather than in the late-stage, with better disease control prior to infusion leading to improved outcomes and reduced toxicity, particularly for high-risk patients or those with functional high-risk disease relapsing sooner than expected.
Panelists discuss how the CARTITUDE-4 subgroup analysis demonstrated that cilta-cel provides significant progression-free and overall survival advantages over standard of care across all patient subgroups, including those with high-risk cytogenetics, extramedullary disease, and varying numbers of prior therapy lines.
Panelists discuss how the 5-year follow-up data from CARTITUDE-1 shows 33% of patients remain alive and progression-free at 5 years with sustained minimal residual disease (MRD) negativity, suggesting the potential for functional cure in multiple myeloma, with lower disease burden at infusion being a key predictor of long-term remission
Panelists discuss how early referral for chimeric antigen receptor (CAR) T-cell therapy is crucial for accessing clinical trials and achieving optimal outcomes, with comprehensive patient education covering unique adverse effects such as cytokine release syndrome (CRS), neurologic toxicities, and secondary malignancies balanced against extraordinary efficacy data.
Panelists discuss how post-chimeric antigen receptor (CAR) T follow-up care involves coordinated joint visits between academic centers and community oncologists for the first 3 months, with ongoing education about delayed toxicities such as cranial nerve palsies, parkinsonism, and immune effector cell enterocolitis
Panelists discuss how emerging chimeric antigen receptor (CAR) T-cell therapies such as anito-cel show promise with potentially reduced neurologic toxicity while maintaining efficacy, and dual-targeting approaches such as CD19-B-cell maturation antigen (BCMA) constructs may provide better long-term remissions by targeting potential myeloma stem cell populations.
s discuss how belantamab mafodotin should be sequenced with chimeric antigen receptor (CAR) T-cell therapy, noting that prior B-cell maturation antigen (BCMA)-directed therapies can reduce CAR T efficacy and recommending CAR T first when patients are candidates.
Panelists discuss how bispecific antibodies are integrated into relapsed/refractory myeloma treatment, with GPRC5D-targeted agents preferred for bridging to chimeric antigen receptor (CAR) T-cell therapy and B-cell maturation antigen (BCMA)-targeted agents for non-CAR T candidates.
Panelists discuss how real-world bispecific data shows slight efficacy drops compared with clinical trials but still demonstrates effectiveness in patients who wouldn't meet trial criteria, particularly for bridging to chimeric antigen receptor (CAR) T-cell therapy
Panelists discuss how they've transitioned to outpatient step-up dosing models with robust supportive care protocols, including pneumocystis jirovecii pneumonia (PJP) prophylaxis, intravenous immunoglobulin (IVIG) therapy, and hospital-at-home support teams.
Panelists discuss how to identify and manage GPRC5D-related toxicities, including skin rash, nail problems, and dysgeusia, emphasizing patient education, nutritional support, and dose modification strategies.
Panelists discuss how the RedirecTT-1 combination of talquetamab and teclistamab shows promising efficacy in extramedullary disease (EMD) with a 79% overall response rate, though with increased infectious complications.
Panelists discuss how academic centers can partner with community practices through early engagement, initial step-up dosing support, and education to overcome barriers to bispecific adoption.
Panelists discuss how trispecific antibodies targeting multiple antigens show promise for preventing antigen escape, while identifying ultrahigh-risk patients, frail patients, optimal treatment duration, and therapy access as key unmet needs.
