Dr Chari on the Use of Ide-Cel and Cilta-Cel in Relapsed/Refractory Multiple Myeloma


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Ajai Chari, MD, discusses the use of the CAR T-cell therapies idecabtagene vicleucel and ciltacabtagene autoleucel in the treatment of patients with multiple myeloma.

Ajai Chari, MD, director, clinical research, Multiple Myeloma Program, UCSF Helen Diller Family Comprehensive Cancer Center, discusses the use of the CAR T-cell therapies idecabtagene vicleucel (ide-cel; Abecma) and ciltacabtagene autoleucel (cilta-cel; Carvykti) in the treatment of patients with multiple myeloma.

Currently, ide-cel and cilta-cel are the only 2 CAR T-cell therapies that are FDA approved for the treatment of patients with relapsed/refractory multiple myeloma, Chari begins. Cilta-cel was approved by the regulatory agency in February, 2022 for patients with relapsed/refractory disease following 4 or more prior lines of therapy, including a proteasome inhibitor (PI), an immunomodulatory agent, and an anti-CD38 monoclonal antibody. Ide-cel was approved in March, 2021 for patients with relapsed/refractory multiple myeloma who have received 4 prior lines of therapy, including an immunomodulatory agent, a PI, and an anti-CD38 monoclonal antibody. The FDA approvals of ide-cel and cilta-cel were supported by the phase 3 KarMMa-3 (NCT03651128) and phase 1b/2 CARTITUDE-1 (NCT03548207) trials, respectively.

Although both CAR T-cell therapies have indications in similarly heavily treated patient populations, Chari believes that cilta-cel has the advantage between the 2 treatments. This opinion is based on the efficacy data seen with the agent, with a beneficial overall response rate of 97% (95% CI, 91.2%-99.4%), and a median progression-free survival (PFS) of 34.9 months (95% CI, 25.2-not evaluable), Chari explains. However, it is important to remember that cross-study, single-arm comparisons are not always recommended, and should be done with caution, Chari emphasizes. However, the median PFS associated with ide-cel in KarMMA-3 was 13.3 months, and the complete response rate was 39%, he says.

Overall, Chari imparts that these efficacy results derived from research into these CAR T-cell therapies speaks to the unprecedented efficacy of cilta-cel. He goes on to emphasize to his colleagues that they should treat patients with cilta-cel instead of ide-cel, if possible. Ide-cel may still be used in patients whose disease is BCMA inhibitor–naïve, or those who do not have immediate acces to cilta-cel, he concludes.

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