Dr. Doris Hansen from Moffitt Cancer Center shares an overview of the testing and evaluations that a myeloma patient may undergo before CAR T-cell therapy. Dr. Hansen also covers practical factors, like the importance of having a caregiver, logistics and travel for care, and provides key questions that patients should ask their doctor about CAR T-cell therapy.
Dr. Doris Hansen is an Assistant Member in the Department of Blood and Marrow Transplant and Cellular Immunotherapy at Moffitt Cancer Center in Tampa, FL. Learn more about Dr. Hansen.
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Transcript
Katherine Banwell:
What testing should be done before undergoing CAR T-cell therapy?
Dr. Doris Hansen:
So, CAR T-cell therapy is an incredible treatment, and as noted, has really changed the way we practice and treat myeloma, it is complicated. There are several steps that we have to take to make sure that the patient is healthy enough, and there are no medical issues or problems that could create safety concerns for patient down the road.
But generally, testing includes – it’s very extensive. It includes checking your heart and your lungs, and we look at liver. We look, as well, at disease restaging. So, that will include a PET scan to see how much myeloma we have, and it will also include a bone marrow biopsy to also assess the level of multiple myeloma cells that might be in the bone marrow. In addition to just laboratory values to assess myeloma protein light chains, as well as just our general CBC, which looks at your red blood cells, your white blood cells, as well as your kidney and liver function, among other things.
Katherine Banwell:
When someone is making the decision to undergo CAR T-cell therapies, a therapy, rather, what factors should be considered, as far as age –
Dr. Doris Hansen:
Yeah, that’s a great question. I do believe that there is transplant eligibility, and then there’s CAR T eligibility, and I can’t say that those two things are really the same.
Generally, I would say that most patients are CAR T eligible, and should be assessed by a CAR T, or an immunotherapy, or academic treatment center. Because, for example, as you mentioned, age. Well, really, what we’ve seen – although this might be a bit biased. But older patients tend to do just fine with CAR T-cell therapy. They have nearly equivalent outcomes, if not better, in terms of efficacy, and they do okay with the right supportive treatment. So, I don’t think age is a problem.
Certainly, I might consider if somebody – there’s also logistical considerations. So, if somebody does not have a caregiver, that might be a logistical issue. Or if somebody might have disease that is relapsing very fast, we might need to do another treatment first before we go to CAR T to prevent any complications. Or if a person can’t get to an academic center.
But generally speaking, we do have support programs. The companies have support programs to really help our patients with travel, logistics, lodging, all of these things, to really be able to get some of these lifesaving therapies.
Katherine Banwell:
Dr. Hansen, what questions should patients ask their team about CAR T-cell therapy?
Dr. Doris Hansen:
I think it’s really important to be able to understand, “How well does this CAR T work? What is its potential for long-term benefits?” But also, most importantly, “What are some side effects from this treatment? And how do those side effects look in the short term? How might that look in the long term? What are the different CAR T treatment options that might be available to you? What might be happening in the clinical trial space? Are there any clinical trials that you might be eligible for? And also, what might be some alternatives?”
And one important question that is currently in the myeloma space is – well, we have, as I mentioned, we have CAR Ts. We have bispecifics. Now, we have some trispecifics. Basically, those are immunotherapies that targets three different areas. But how should we sequence them? Which one should we give first? What is the best way to sequence them, so our patients get the most benefit?
So, I think just being aware of what is available, commercially approved, what’s in clinical trial, and what might be the best way to sequence these types of treatment? And what are the logistical considerations as well, as we move forward with these immunotherapies?