Largest Comprehensive Study Compares Efficacy of CAR T Products for Multiple Myeloma
A large, comprehensive study comparing two popular chimeric antigen receptor T-cell therapies (CAR T) — idecabtagene vicleucel (ide-cel) and ciltacabtagene autoleucel (cilta-cel) — has found that while one therapy is more effective, it also carries a higher risk of certain side effects.
The study led by Doris Hansen, MD, of Moffitt Cancer Center’s Blood and Marrow Transplant and Cellular Immunotherapy Department, and Lauren Peres, PhD, a researcher in Moffitt’s Cancer Epidemiology Program, included 641 patients across 19 medical institutions in the U.S. The research aimed to compare the success of the two CAR T drugs in treating patients with relapsed/refractory multiple myeloma.
Hansen presented the findings in San Diego at the 66th annual meeting and exposition of the American Society of Hematology.
Hansen explained that cilta-cel showed significantly better survival outcomes compared to ide-cel but also came with higher rates of certain toxicities, including severe cytokine release syndrome, infections and delayed neurological side effects. Both therapies have been recently FDA approved with ide-cel initially approved in 2021 and cilta-cel in 2022.
In lieu of a head-to-head clinical trial directly comparing these two therapies, this study provides one of the most comprehensive analyses available to help physicians and patients make informed decisions about CAR T-cell therapy.
“While cilta-cel offers better survival rates, it may not always be the best option for every patient due to its higher risk of side effects,” Hansen said. Treatment decisions should be personalized, depending on each patient’s unique circumstances.
For example, older patients or those with other medical conditions may be better suited for ide-cel, despite its slightly lower survival rate, because of its reduced toxicity.
“CAR T-cell therapy is a highly personalized treatment approach, and factors like a patient’s overall health must be considered,” Hansen said.
The study findings should help guide clinical decision-making, patient counseling and the selection of appropriate CAR T product based on individual patient needs.
CAR T-cell therapy is an innovative treatment that uses the body’s own immune system to fight cancer. By genetically modifying a patient’s T cells to recognize and attack cancer cells, the therapy targets cancerous cells while sparing the healthy tissue. CAR T is typically used as a second or third line of treatment when chemotherapy or other therapies have failed.
However, Hansen also pointed out that earlier use of CAR T in a patient’s disease course can lead to better outcomes. Both CAR T treatments are available for patients with relapsed/refractory multiple myeloma, but the choice of which therapy to use will depend on individual patient factors.
