Noopur Raje, MD, director of the Center for Multiple Myeloma, Massachusetts General Hospital Cancer Center and a professor of medicine at Harvard Medical School, discusses the rationale for CAR T-cell therapy in multiple myeloma.

The field now has a good target with regard to BCMA and most cellular therapy products are targeted against this, says Raje. This approach differs from antibody-drug conjugates (ADCs) and bispecific antibodies because CAR T cells have to be generated. As a part of the process, T cells are taken from a patient before being genetically modified and returned to the patient. Although the process is different, the idea is the same: CAR T cells target and kill cancer cells. The approach comes with certain adverse events that the field is familiar with, such as cytokine release syndrome and neurotoxicity. The events associated with the CAR T-cell products used in the multiple myeloma space have been very manageable, which Raje notes is pleasantly surprising. This may also be because the field has gotten better at managing these toxicities.

With CAR T-cell therapy, the field is seeing deep and durable responses among patients who did not have any other therapy options available, adds Raje. Given the efficacy of CAR T cells, investigators are examining this approach earlier on in the course of myeloma treatment. National and international trials are evaluating cellular therapy at first relapse or at initial diagnosis. It is an exciting area of research in myeloma, concludes Raje.