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2yr
CAR T-cell therapy in heavily pretreated patients with RRMM

Idecabtagene vicleucel (ide-cel) is a B-cell maturation antigen–directed chimeric antigen receptor (CAR) T-cell therapy that has demonstrated clinical activity in RRMM. It also yielded the expected CAR T-cell toxic effects in these patients.

Per the results of the KarMMa trial, ide-cel mediated responses in most heavily pretreated patients with RRMM; MRD-negative status was attained by 26% of those administered treatment.

Notably, patients with diverse patient characteristics were included in the study (n=100). Patients were aged 33-78 years (median age: 62 years), and 37% harbored high-risk cytogenics. Furthermore, 36% of patients exhibited extramedullary plasmacytoma.

In a real-world study, U.S. researchers found that in 159 leukapheresed patients, ide-cel was as safe and effective as in the KarMMa trial. Moreover, 75% of infused patients would not have been eligible for participation in the KarMMA clinical trial due to comorbidities at the time of leukapheresis.

Which patient characteristics guide your clinical decisions in the treatment of RRMM?

  • 2yr
    I look at the treatment history, exposure to Imids, PIs, mAbs, BCMA-targeted agents, tolerance of prior treatments, cytogenetic profile comorbidities, PS, and availability of well-designed clinical trial before making a decision regarding the next treatment.
  • 2yr
    In addition to the above mentioned issues of performance status, prior therapy status, responsive vs refractory to last line of therapy, and patient preference, the limited number of CAR-t centers put additional non clinical barriers up; can the patient and their family be away from their home/work for up to a month? The financial hit for being off work for a month may be more than the family can tolerate, yet CAR-t requires presence of a support and/or caregiver for the duration of the CAR-t initial treatment and post treatment follow up.
  • 2yr
    Which patient characteristics guide your clinical decisions in the treatment of RRMM?

    Performance status, comorbid conditions previous treatments received, patient willingness to travel for CAR-T therapy .
    generally will reserve CAR-T for multiply refractory patients. However seems logical to consider in early lines of therapy such as beyond 2 lines.
    The results of the KarMMa trial are encouraging
  • 2yr
    I agree- ECOG PS, Social support for CART (patients ability to travel, care givers ability to travel). - would consider this in penta-refractory patients
  • 2yr
    As per usual, age, PS, comorbidities, what they got, how they responded/tolerated, what is left, what the patient goals are, how aggressive they want to be..... All of these are important.
  • 2yr
    As with most oncology pts, performance status and comorbidities are paramount in guiding treatment decisions. In addition, since we are contemplating CAR-T therapy, social/family support, motivation, and access are also important.
  • 2yr
    Co morbid status, social support and if someone can travel for more aggressive therapies such as car t or transplant. If these all check okay we will send for evaluation. If not then we think about non aggressive palliative therapies.
  • 2yr
    The primary factors are co morbidities, performance status, ability to withstand an interval without therapy to allow product preparation, and the numbers of prior therapies.
  • 2yr
    I look for their PS and recent prior therapies as well las the family and social support they have, especially if we are looking at intense therapies like CAR-T or a BI-Specific
  • 2yr
    Mainly Performance Status, comorbidities also what previous treatments patient has received Pt should have progressed on proteosome inhibitions,imid refractory,anti-CD38
  • 2yr
    good PS, no significant comorbidities, refractory to other standard chemotherapy, good social support
  • 2yr
    The real world data is comparable to the clinical trial data. This is also relatively true for cilta-cel (Carvykti). These Car T cell therapies are "one and done" although not curative-this is still the optimal way to improve patient QOL. However, these therapies are essentially limited to academic centers or academic-related private centers. In contrast, with appropriate training and desire, the bispecific antibodies can be administered by local oncologists-even with training I am uncertain how many really want to deal with the REMS, training, risk of CRS/ICANS-but possible.
  • 2yr
    good kps ,access to therapy,affordability and few comorbidities
  • 2yr
    I make sure the patient is refractory to Imids, PI, CD38 before considering a patient to CAR-T. they also need to have good social support, caregiver support inorder to receive the treatment.
  • 2yr
    I feel the requirements for CART is somewhat less than SCT but not by much and therefore some decent KPS is required to pursue it
  • 2yr
    Patients performance status, comorbidities, logistics, patient motivation as to how aggressive they want to be and if willing to travel to the CAR-T sites.
  • 2yr
    4 prior lines of therapy, penta refractory disease, good organ function reserve, and patient’s willingness to travel to a car-t cell center and spend 30 days close to the center
  • 2yr
    Penta refractory, no history of autoimmune disease or transplant, good family support, willingness for hospitalization, strong insurance coverage
  • 2yr
    It depends a lot on social support and willingness to travel for me as it is not offered locally.
    Patient needs to be pentarefractory and with an acceptable performance status.
  • 2yr
    I rely on myeloma risk classification, performance status, comorbidities to decide on treatment regimen. Age, side effect profile, ease of administration are other things to consider. I also discuss about role if transplantation. Once they have exhausted first few lines of treatment, I then refer for trials and CART therapy
  • 2yr
    Would consider use post 4 lines of therapy (though can be combination of multiple agents in the prior lines). It is a one time treatment and centers are learning more on better management the toxicities.
  • 2yr
    I think in daily community practice, I would want to know about prior therapies received in terms of drug class such as imid, anti cd38, pi, etc. also performance status is important as well. i happen to practice in a location where the nearest car-t center is over 300 miles away so while several of my patients are clinically eligible, their social and financial means will not allow them to make car-t feasible. good ecog of 0 or 1 is preferred. age is less relevant if the patient is in good physical shape with minimal comorbidities
  • 2yr
    Depends upon the patient's comorbidities, prior therapies used including proteosome inhibitors, immunomodulatory agents, anti-CD38 antibodies, side effects from prior therapies, triple refractory versus penta refractory, performance status, high risk by genomic profiling, social support and ability to travel and stay around tertiary centers if they qualify for CAR-T cell therapy or willing to be admitted to the hospital for starting bi specific antibody therapy
  • 2yr
    penta refractory, ECOG PS 0-1, decent social support and adequate insurance coverage.

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