Carvyktri seems to outperform Abecma in OS, PFS, ORR but usage has been heavily limited my manufacturing slot availability. Have used both CAR-T products in place of transplant for good performance status patients and in triple refractory patients 3L and beyond. All have had good responses. Increasing usage of tecvali for triple refractory patients who cannot tolerate CAR-T or cannot receive due to manufacturing delay, especially w Blenrep pulled from market.

i think Ide-Cel has potential role IN THE PLACE OF TRANSPLANT /instead of transplant; otherwise, its a very valuable tretament option; concern si getting slots, enrollment speed is a concern(slow -pt had to wait), toxcitiy is still a concern; otherwise, love to put patients on this tretament; but once again, in community, I dont get to chose what CAR-T type or even ay CAR-T to that matter - as its decided by cellular therapy expert/ transplanter;
No Doubt its a great option, but BCA ADCs are ready to use off-shelf - we community oncs gets hand on and get comfortable soon -

I don't have personal experience with CAR-T cells, I referred patients to tertiary centers for consideration, even though cross-trial comparison Cilta-cel has more overall response and complete responses, with higher toxicity compared to Ida-cel, however, the study population is different which can affect these numbers. At present we don't have the luxury to choose which CAR-T - due to the limited number of slots available, it depends on the availability at the referred tertiary center and what they can get if they are eligible.

I think all the CAR T therapies have look promising in R/R MM. However, there is still a very large logistical burden in getting these patients slots and having them travel to tertiary care facilities. Pharma needs to figure a way to partner with community oncology groups in order for this to be rolled out in community in general. Multiple community groups are planning and going to use BITE molecules as these can be given in the community.

CAR-T is exciting, first exposure was with NHL ,pt was almost dying and now working full time after successful therapy. It has come long way and will shape future of blood cancer therapies.

I believe that earlier use of car-t will be more promising as pts are in much better health.
in my opinion bispecific will have more role because of easy availability ease of use

CAR-T products have shown impressive responses in heavily pretreated , compared to idacel , has better Pfs , as well as deep responses as well as improved RR there is no head to head comparison between both citacel or idacell Sequencing among BCMA/non-BCMA CAR-T products/bispecific agents is an ongoing area of research also the adverse effects of these treatments, including CRS, neurotoxicity, infections, might preclude them to use for some patients who have been heavily pre-treated in the past.

Haven't yet had experience with either abecma or carvykti due to limited number of slots available in the community. But for patients of mine that have been treated, the response rates have been pretty deep so far. The main problem is access to these drugs with long waiting lists- so bispecifics may become a prominent role if more are approved and off the shelf agents.

Once the availability of these products, the bottlenecks, resolve then CAR-T will be much bigger part of my practice; the BCMA directed therapies will add a new MOA and a new dimension of treatment options. I am concerned about the unique AE's related to the BCMA's and even some potential unknowns, neurological and problems perhaps of second malignancies.

I hope we are just at the beginning of the CART journey. It is a revolutionary technology but with many shortcomings. As a community practitioner I don't have the ability to administer it myself. I need to refer out and since there is such limited availability access is a problem. In addition the time it takes to produce the product and organize the health care delivery system translates into some patients falling off the path since they can't wait. Turning to efficacy- despite its high response rate it is often for a limited period of time. Lastly there is the financial toxicity to the individual patient and to society. I am optimistic that with great effort and ingenuity these deficiencies will all be corrected.

Ciltacel produces more CRs with cross trial comparison
Toxicity comparable.

BCMA Bispecifics would have a role either before CAR T as bridge or after , as salvage

I personally do not have experience with CART treatment. It appears that it is very promising. I will refer appropriate patients to a center doing the procedure.

we have to refer out for CART therapies-over 1 hour away-have seen deep and durable responses with delays and slot availabilty iscproblem
off the shelf trweatments may be more convenient for physicians and patients

hard to differentiate between the 2 car t cell therapies due to different pt population,more so there is no tail of the curve as you see with lymphoma
my belief is that bispecific antibodies will move before car t and also allo or off the shelf car t may be the future

I generally agree with the above comments - CAR-T products have shown impressive responses in heavily pretreated patients. I have had similar experiences with both BCMA products, with several patients demonstrating complete and durable responses, but a few with high risk profiles that have relapsed within 3-4 months of CAR-T. Sequencing among BCMA/non-BCMA CAR-T products/bispecific agents is an ongoing area of research and will be critical to optimize therapy for our patients.

I view them as comparable so depends on slot availability would chose one drug Vs other car T cells

Would consider both car-t cell products as slots allow, with carvicti having better data than Abecma, with tecvayli being a nice off the shelf option if car-t unavailable or pt is later line

I think with BITEs there will be more room for CAR-T patients at academic centers

I have had personal experience using ABECMA in my patients. I had seen good responses and reasonably good tolerability in my patients.

Abecma and Karvikty are both BCMA targeting CART cells approved for MM. The ORR and PFS rate are higher with Karvikty. I believe CART will become used more frequently once we overcome manufacturing delays and move to the outpatient setting.

Since ide cel has been approved by the FDA, we have been allotted 2 slots of month. Our results for the commercial product appear to be similar to the KarMMa two data. What is NOT mentioned in the above write-up is the cilta-cel data. The data is much more impressive: overall response rate 98%, CR 80% and PFS guestimated at 31 months. However, even though the populations were somewhat similar, the number of high risk patients and those with extramedullary disease was lower in the cilta-cel study compared to the ide-cel study. Thus, the two studies are not directly comparable. We have been allotted 2 cilta-cel slots a month. Again, our patient results appear to be similar to that reported in the phase1/2 results. I think both products will have a place in the future treatment of myeloma patients, even more so when manufacturing issues have been resolved for BOTH products and when they are FDA approved for earlier use-currently for patients with 4 prior therapies. Teclistamab, the first bispecific in myeloma, was approved ~ 2 months ago for patients with 4 prior lines of therapy. Overall response rates are approximately 60-65%: CRS and neurotoxicity are also seen although at a lower level than that observed with ide-cel and cilta-cel requiring hospitalization for the 3 step up dosing schedule. This is a weekly treatment versus 'one and done' with Car T cell. Our group preferentially opts for the CAR T cell for higher responses and a single treatment course but given the limitations of product manufacturing for both the Car T cell products, Tevayli is certainly an option. Sequential BCMA targeted therapy is a consideration although responses and PFS for teclistamab AFTER a Car T cell are modesl.