Dr. Krina K. Patel of The University of Texas MD Anderson Cancer Center discusses when and how patients with multiple myeloma should start conversations about CAR T-cell therapy. She explains why early planning and timely referral to a CAR T center are critical, how treatment timing affects eligibility and outcomes, and how CAR T is now being studied in earlier lines of therapy, including for newly diagnosed and high-risk patients.
Dr. Patel also reviews ongoing frontline clinical trials and shares practical guidance and an [ACT]IVATION tip to help patients advocate for themselves and explore CAR T as a potential treatment option.
Related Resources
Transcript
Lisa Hatfield:
Dr. Patel, you’ve been involved in CAR T research and clinical care from its early development through its use in earlier lines of therapy, so you’ve seen how timing can directly affect patient options. So if a patient is interested in CAR T, how and when can they raise the CAR T question in their myeloma journey? And do they have to wait until disease progression?
Dr. Krina K. Patel:
That’s a great question, and multiple questions that are fantastic, and I think it’s been an evolution of us learning about this, and so, you know, we always used to say that if our patients were relapsed/refractory, and needed CAR T, you know, it’s a little bit more of a high-maintenance therapy in that we do need timing. Timing is really important.
Our biggest goal is that for anyone that’s interested, we want to make sure, number one, that they actually get to the cell infusion.
So, their disease has to stay controlled during that bridging period, so, you know, we collect the cells, then it takes about 4 to 6 weeks for most of our current CAR Ts to be made and produced before we can get them back. And then they get their cell infusion. So, we want a 100% response. You know, of course, the ability to give the cells, that’s the main thing.
In the past, in relapsed/refractory patients, not all patients would make it through that time period to get their cells, and so what we would say is, try to tell your doctors to have you see a CAR T specialist. Or if your doctors are doing CAR T, tell them about it so that one line before it’s approved, that we’re ready to go, so that we are anticipating that the second it looks like your numbers are going up, or your myeloma current treatment’s not working, we can start getting, you know, everything ready to move forward.
Today, we have second-line CAR T already, and so again, you know, even when you’re first diagnosed, and you just say, hey, I’m interested in this, that helps, for patients coming to me from other centers. That helps us say, yep, you’re on the right treatment right now, your response is great, hopefully with the current new induction therapies, you’re going to do really, really well for a long time.
But, if we do need to get, you know, CAR T soon, then we want everything, you know, ready to go if the numbers are going up. So again, the second you say I think CAR T is the right thing for me, talk to your doctors about it. And if it’s something that you are eligible for, then, you know, getting to the right centers to do that.
There are clinical trials that have already been done in frontline, but even there’s more clinical trials right now that are being done in frontline. So, even for newly diagnosed patients, obviously, if this looks like it’s something important, that you really are interested in having your doctors talk to those centers that have those trials.
Lisa Hatfield:
Okay, thank you. So, when you mentioned newly diagnosed patients, you’re looking at CAR T in those newly diagnosed patients, does that mean that they would go through so many months of induction therapy and then CAR T and no stem cell transplant? Or would this be CAR T just by itself? What would that mean for a patient?
Dr. Krina K. Patel:
Yeah, no, those are great questions. So, we already had CARTITUDE-5 and -6 that were done, right? So those are fully enrolled. Meaning that, that trial is done. So there are no active new patients they’re putting on there, but one of their trials, CARTITUDE-5, was, anyone who doesn’t go to transplant, they would get CAR T, everybody would get the CAR T as consolidation, and they get maintenance. I think the maintenance for about 2 years.
Same thing with the CARTITUDE-6, but that one is a trial that was randomized, so patients either got transplant, or they got CAR T as their consolidation after their induction therapy. And then they got maintenance again for a couple of years. We don’t have data yet from the results of those. They’re looking at MRD and progression-free survival, so hopefully in the next year or two, we’ll see some of that.
But there are certain clinical trials right now that are using CAR T, like the Gracell study, the AstraZeneca CAR T that is CD19 plus BCMA. They’ve done a lot of studies in China, but there is a study now looking at frontline for patients who have high-risk disease, and just instead of transplant, getting CAR T.
They also have some studies opening for randomized just like the CARTITUDE-5 and -6. Their studies are called DURGA, and so they have, I think DURGA-5 and -6 that are opening as well. So, yes, instead of, or as a comparative arm to transplant.
Lisa Hatfield:
Okay, awesome. And do you have an [ACT]IVATION tip for a newly diagnosed patient who might be interested in CAR T?
Dr. Krina K. Patel:
Yeah, I think the biggest thing is, the second you know that this is the right thing for you, and you want to learn more about it, even if you don’t know if you want to do it, I think learning more about it is important, and getting to the right centers that do it is really important, so you can discuss eligibility, as well as sequencing, and when the right time for you is.