18th International Myeloma Workshop
Clinical outcomes of relapsed/refractory multiple myeloma patients after BCMA-targeted CAR T therapy
Dr Oliver Van Oekelen - Icahn School of Medicine at Mount Sinai, New York City, USA
The talk discusses the clinical outcomes of patients when they relapse on BCMA-targeted CAR T therapy. Recently we’ve seen the approval of Abecma on the US market and we know that there are other CAR T products on their way. So we wanted to ask the question what is the best approach to patients when they relapse on this therapy because we know that even though there are more and more treatment options for myeloma, as patients progress into later lines of the disease or relapse more often it becomes harder to treat. The prognosis for patients with this highly refractory disease is somewhat limited and so we wanted to study the outcomes and see what salvage therapies would be efficacious and would be tolerable in these patients.
How effective is BCMA targeted CAR T therapy in comparison to other therapies?
The results that we’ve seen from BCMA-targeted CAR T therapy so far are very promising, it being used in highly refractory patients or patients that have received a lot of prior therapy. We’ve seen very, very impressive response rates in which almost all patients had deep responses of their myeloma. The durability is somewhat of an outstanding question and as the data continues to come in we’re curious to follow it and see how durable the responses are. Certainly it appears that so far we haven’t been able to really see a stagnation of the survival curve, that is it doesn’t seem to be curing the patients in contrast to CAR T in some other diseases. But currently there are a lot of ongoing studies investigating CAR T in earlier lines of therapy and perhaps in combination with other treatments that might be able to answer the question as to what is the best approach and what is the position where we should use CAR T. That being said, at this time we have patients that have received a lot of prior treatment relapsing after CAR T and we wanted to see, for example, if it would make sense to switch them to another T-cell targeted regimen like a bispecific antibody and whether or not that would give useful responses. Indeed, we saw in a handful of patients so far, but we’re obviously collecting more data, we saw that these patients had good responses on bispecific after CAR T and we hope to show a similar trend for patients that are treated with BCMA targeted CAR T after a bispecific antibody, highlighting the fact that sequencing of these treatments is useful.
I think it’s particularly important that we were able to present this data because at this point in time a lot of these treatments are offered in clinical trials and they often preclude sequencing of investigational agents. So our data shows that it makes sense to give patients access to these different options of immune-mediated therapy in myeloma sequentially.
What is the future for relapsed/refractory multiple myeloma treatment?
At this point there is so much moving in the field of relapsed/refractory myeloma and that’s a hopeful thing for patients. That’s why we’re trying to treat our patients and give them even a couple more months or a year extra and see what extra treatments become available. I feel there are a lot of moving parts at this time. People are trying to figure out the best position for these novel classes of treatment, that includes BCMA-targeted CAR T, that includes the different bispecific antibodies. We’re anxiously looking at clinical trials and we’re obviously studying our patient population, trying to see where we should position each of these agents.
I’m very hopeful that when we figure out the mechanisms of relapse on these treatments, when we study our patients more and perhaps be able to predict which patients would do well with either BCMA-targeted CAR T or bispecific antibody, that we can rationalise these treatments more and figure out a good sequence that gives patients the best clinical outcome.