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