A New Wave of Progress in The Treatment of Multiple Myeloma: Translating Evidence to Clinical Practice - Episode 15
Shared insight on clinical trial data behind the KarMMa trial of ide-cel, a CAR T-cell therapy, in patients with relapsed/refractory multiple myeloma.
Ajai Chari, MD: Switching gears to ide-cel [idecabtagene vicleucel], can you tell us a little about ide-cel and the latest data we are getting?
Krina Patel MD: We had the New England Journal of Medicine paper last year, and basically, these were heavily pretreated patients, with 6 lines of therapy, and extramedullary disease in about 43% of patients. They were heavily in that group. But again, this was the first CAR [chimeric antigen receptor] T-cell data that were presented, and the overall response rate was 73%. Now, some of those patients got 50 million cells, some got 150 million, and then up to 450 million. For the patients who got 450 million cells, it was an 81% response rate. Again, before we didn’t have bispecifics, then we didn’t have any other CAR T, so that was the first like, wow, we’re seeing these amazing responses in patients with extramedullary disease and who were heavily pretreated. Then we got some of the PFS [progression-free survival] data, and I think the patients who got the 450 million cells had about a year or so. The patients who got the CR [complete response], which was about 40% of patients, got a little longer, like 19 months, as their PFS. Patients who would’ve likely died with any other therapy. And the overall survival [OS] benefit, we see patients now, even though they’re progressing, they’re responding to other therapies afterward, new or even older therapies that they already had. That’s why I think they’re living longer. So, despite the PFS, I think that something happens when they get these immunological therapies that either resets the clone, their microenvironment, their T cells, something that they respond better to the next line.
Cristina Gasparetto, MD: It’s a very important observation. We used to see the same with the allo [allogeneic stem cell transplant]. After they progress through an allogeneic transplant, the patient seems to respond better and longer to therapy. I think we’re seeing this. And to circle back to where we started, the importance of MRD [minimal residual disease]; we started with the newly diagnosed, and now we’re at like 7 lines of therapy, going back to the depth of response, which is kind of interesting.
Ajai Chari, MD: Yes. The fact that we’re talking about MRD is because their numbers are so good. I think it’s striking as you said, PFS was around 8.6 months, but OS is over 22 or 24 months, which is amazing.
Cristina Gasparetto, MD: Exactly. It’s amazing.
Transcript edited for clarity.