Is CAR T-Cell Therapy Right for Your Myeloma? Understanding the Process

Katherine Banwell:

Let’s start by understanding the timeline for CAR T. Would you provide an overview of the process?

Beth Faiman:

Oh, absolutely. So, CAR T-cell therapy or Chimeric Antigen Receptor T-cell therapy, CAR T therapy, is a specialized therapy for patients with multiple myeloma and other blood cancers that programs your own healthy T cells to become fighters in the blood stream. Again, it’s a type of immunotherapy using your own cells, so, we’re engineering these to be fighters.

The blood is collected like you’re donating blood from a catheter through a process called apheresis, and the cells are multiplied in the lab and grown. But this is a long process, and it starts with a referral to a CAR T-cell center.

We used to give this treatment after four or five prior lines of therapy. Now, we have clinical studies that are showing that it might be effective in early, newly diagnosed patients. So, the things to remember and share with your friends and your friends’ friends and support groups and whoever you speak with is an early referral is important because it starts with meeting the CAR T-cell center.

And then, we check and discuss through shared decision-making, “Is this therapy right for you,” discussing the risks and benefits and alternatives.

And then, we get the financial clearance. And then, we talk to your insurance company and make sure all is approved. We have physical, financial, and other screenings. And then, we go to harvest your T cells once it has been an approved process through your insurance, and you decide to proceed.

Then, there’s this period of about six to eight weeks, sometimes as low as four weeks, to manufacture those cells before they’re given back to the person. So, this is a lengthy process. And again, we don’t want you to be pressured to make this decision. And it’s important to meet with a team and establish trust and find out if this is right for you early on so that you can get this therapy that might be right for you sooner than later.

Katherine Banwell:

Let’s discuss how CAR T has changed for patients in the last couple of years. You touched on it a moment ago. It’s starting with the earlier use of this therapy. When does the therapy fit into a myeloma treatment plan now?

Beth Faiman:

So, this is such an interesting question, and I appreciate you asking it because that is the biggest thing that has stuck out for me. There are a few features of CAR T-cell therapy in myeloma, and that’s really the big one is the earlier utilization. There was a study called CARTITUDE-4 that showed that when patients received earlier aligned CAR T-cell therapy, we now know that one in five patients are still in a really deep remission and not progressing.

And so, because of the earlier utilization that was found to be supported in the study, you can have it as early as one prior line of therapy. So, let’s say you got that four-drug induction at diagnosis, maybe you had a transplant, maybe you didn’t, you would be a CAR T-cell therapy candidate for one of these medications. So, this therapy is rapidly moving to the second- and third-line therapy and even before. We now know also that there’s improved sequencing. Through research because this is a target of what’s called B-cell maturation antigen or BCMA, we program the CAR T cells to fight BCMA and work with the T cells.

We try to avoid BCMA bispecific antibody which is a different type of injection therapy that we give regularly to patients with myeloma because CAR T-cell therapy could be less effective over time. And then finally, the most important thing that most of my patients – and I’ve had hundreds of patients go through this procedure – most important thing patients tell me is that you can’t put a price on being off of therapy.

You don’t have to take any medications or pills or shots. Maybe some things to improve your immune system and prevent infection such as antibiotics or antivirals, but you’re not taking chemotherapy daily or weekly. And so, that is priceless. So, not only are we moving this therapy earlier, we have a better knowledge of how to sequence the therapy, and we’re recognizing the benefits that the patients are experiencing.

Katherine Banwell:

Dr. Faiman, how do you know which myeloma patient CAR T-cell therapy is right for? I mean, can you really predict who will thrive with this therapy?

Beth Faiman:

Well, that’s an excellent question. You have so many great questions today, and that’s an excellent question, too, because what we’re finding is that, really, age is just a number. And I mention that because whenever we decide what therapy might be best for a person, we think of, “What’s their physical, financial, social situation? What are their needs, their desires, their goals?”

Some people want to go for a cure, and they want to do a more aggressive therapy. And we talk about the tradeoffs. Short term with CAR T, there’s that two, three, four process of screening, financial clearance, needing a caregiver. But then, when you’re finished, then we can just surveil you and watch you closely to make sure that you’re progressing or having any problems with infections or other complications, and we’ll talk about that a little bit more later. But when we’re personalizing therapy, it’s really anybody is a candidate.

I mentioned the statistics earlier that only 20 percent of patients around the country in the United States are getting the CAR T-cell therapy which is potentially curative for a lot of people. So, again, we just trying to talk about what’s best for that patient. But really, anybody after one prior line of therapy should be considered for this innovative therapy.