VIDEO: Discussing common questions about CAR T-cell therapy with myeloma patients

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I think one of the most common questions that patients have is, “Is CAR T-cell therapy right for me? How quickly I can get it?” And I think it's very important for us to have the discussion with patients around the optimal timing. That's why I actually share with my community oncology colleagues that once your patients are getting to that third line of treatment, it’s a good idea to engage your transplant cellular therapy center of choice or excellence that’s close by and make sure that the patients are kind of plugged in. So when they do need those therapies, they can be logistically managed that way because the disease has to be under reasonable control before T cells are collected for patients. And then the disease has to be controlled during the time that the manufacturing takes place.

So you explain these things to patients as well as to physicians. And then, of course, the kind of side effects: what is cytokine release syndrome and how we manage it; what are the neurologic side effects and how we manage them; what are the infection risks and how we manage them for patients; what are the prophylactic measures we take care of for patients or introduce into their treatment to mitigate that infection risk. All of these things are important considerations.

And then also talk about the rare side effects and what happens when, if the blood counts do not recover, what happens if they do develop some new neurologic side effects? I think one of the particular side effects that’s gaining a lot of coverage right now with early reports and also from the FDA perspective is the chance of getting other cancers if you received CAR T-cell therapy, and it’s a complicated issue that you have to explain to patients. Myeloma patients who have received transplants and lenalidomide as maintenance treatment are at a higher chance of developing other cancers down the line. And many of the patients who are getting CAR T-cell therapies have received transplant and have exposure to lenalidomide. So we are still trying to tease out what’s the effect of these therapies and won’t get that answer until CAR Ts are compared to transplant in the front-line setting. But it’s an important aspect to discuss with patients. And then very, very rarely the CAR T cell itself can introduce T-cell clonality, leading to T cell kind of cancers — where it happens extremely rarely, but that’s something that has also been highlighted by FDA to something to discuss with patients.