This could be much more than just another line of therapy, experts say.
Patients with multiple myeloma are responding so well to chimeric antigen receptor T cell therapy that some are talking about the possibility of curing the disease.
Speaking at the recent American Society of Clinical Oncology meeting in Chicago, haematologist Professor Melissa Alsina, from the H Lee Moffitt Cancer Center in Florida, delivered an overview of the current and future treatment landscape with CAR-T cell therapy.
The treatment involves harvesting a patient’s own T cells, engineering them with a receptor that targets the B cell maturation antigen – which is expressed on the surface of malignant plasma cells – and reintroducing them.
CAR-T cell therapy has already been used successfully to treat lymphoma and leukaemia, but there’s growing evidence that the approach is even more effective in multiple myeloma.
Dr Alsina presented real-world data of the use of idecabtagene vicleucel (ide-cel) in 159 patients with myeloma, which showed media progression-free survival of 10.3 months and 92% overall survival at six months.
The overall response rate for the treatment was 86%, 32% of patients achieved clinical remission and 78% achieved minimal residual disease negativity.
“These patients are responding well and have an unprecedented survival for this patient population,” Dr Alsina said.
Haematologist Professor Simon Harrison, from the Peter MacCallum Cancer Centre in Melbourne, said it looked like myeloma might become the new “poster child” for CAR-T technology.
“This may not be just another line of therapy in myeloma, it actually might be the start of this different conversation,” Professor Harrison told Oncology Republic. “I think that’s an important stepping stone to actually being a disease that can be cured, whereas historically that’s not been thought possible.”
In the US, there are currently two CAR-T products approved for treatment of multiple myeloma: ide-cel and ciltacabtagene autoleucel (cilta-cel). However, neither are approved in Australia, although Professor Harrison says one is going through the approval process and hopes there will be an update by the end of this year.
Dr Alsina said there is also work underway to improve the antigen targets for CAR-T therapy in multiple myeloma, so that they bind better to the myeloma cells. Early work in this space suggests even higher response rates and better safety profile than the existing target.
Other avenues that researchers are exploring include allogeneic CAR-T cells, culturing the T cell population with an inhibitor that enriches them for a more memory-like phenotype to induce a long-lasting effect, and also using T cells that have lower immunogenicity so they can better infiltrate tumours.
Given the effectiveness and safety profile of CAR-T therapy in multiple myeloma, there’s also a move to bring it towards a first-line treatment option, Professor Harrison said. “The earlier you deploy the most effective technology, the more likely it is to get to the desired result.”
