VIDEO: CAR-T has been ‘instrumental’ in multiple myeloma

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Chimeric antigen receptor T-cell therapy has been really instrumental in how we treat patients with myeloma. It has really changed the face of how we treat this disease, so since 2021, we've had two products that have been approved, so two commercial products.

We started with ide-cel, or Abecma, and then with cilta-cel, or Carvykti, and initially, we were using a lot of ide-cel before cilta-cel came out, and then cilta-cel came out, and for the most part, I think a lot of centers have been using cilta-cel more commonly than ide-cel, and this is because cilta-cel has really shown better responses, more durable responses, although the safety is kinda similar in terms of what they expect with side effects, so cytokine release syndrome is something that we're used to with the available CAR T-cell products. ICANS, which is neurotoxicity, is something also that that we're used to.

Now, something that we're trying to learn still about is delayed neurotoxicities with CAR T-cell therapy. So far, we have seen delayed neurotoxicities with cilta-cel in the real world and in clinical trials, although in clinical trials, the incidence rate was really lower when we did CAR T earlier, so when we did CAR T earlier in the cART24 study of cilta-cel, the first relapse and after, the incidence of delayed neurotoxicities was actually lower with Parkinsonism and and such, which is a good thing, so hopefully, by moving CAR T earlier in the paradigm of three multiple myeloma, we'll we'll see less and less of those delayed neurotoxicities.

So now, the main thing in the field is to see whether they're doing CAR T early is actually the way to go and not really delay it, and so far, we know from the cAR24 study that the responses may be more durable if we do CAR T early, the T cells are more fit, and we can get better products and again, better safety, potentially, with less delayed neurotoxicities.