Biomarkers and patient eligibility for CAR T-cell therapies in MM

During the European Hematology Association (EHA) 2023 Hybrid Congress, the Lymphoma Hub and Multiple Myeloma Hub held a joint satellite session on the ins and outs of CAR T-cells in the real world.

Here the Multiple Myeloma Hub is pleased to share the presentation by Shaji Kumar, Mayo Clinic, Rochester, US, on biomarkers and eligibility for CAR T-cell therapies in multiple myeloma.

In this presentation, Shaji Kumar shares the currently approved CAR T-cell products for MM, discussing their up-to-date clinical data (Figure 1). He also shares the limitations and logistical challenges facing the implementation CAR T-cell therapy, as well as the current eligibility criteria for its use (Figure 2).

Figure 1. Efficacy and safety data for KarMMa and CARITITUDE-1*

AE, adverse event; CR, complete response; CRS, cytokine release syndrome; DoR, duration of response; ICANS, mmune effector cell-associated neurotoxicity syndrome; MRD, minimal residual disease; NR, not reached; ORR, overall response rate; PD, progressive disease; PFS, progression-free survival; OS, overall survival; VGPR, very good partial response.
*Adapted Chekol Abebe, et al.,¹ Martin T, et al.,² and Munshi, et al.³

Figure 2. Eligibility criteria for the use of CAR T-cell products* 

CAR, chimeric antigen receptor; ECOG PS, Eastern Cooperative Oncology Group Performance Status; SCT, stem cell transplant.
*Adapted from Dave, et al.⁴

Watch or download the presentation to learn more about:

• The myeloma treatment paradigm
• The currently approved CAR T-cell products in multiple myeloma, including their up-to-date safety and efficacy data
• The impact of prior treatment with BCMA therapy on clinical outcomes with CAR T-cell therapy
• The challenges and logistics when considering CAR-T cell therapy
• The limitations of CAR T-cell products
• Eligibility criteria for CAR T-cell therapy

Key points

• Currently, there are no individual biomarkers to definitively determine eligibility for treatment with CAR T-cell therapy.
• Idecabtagene vicleucel and ciltacabtagene autoleucel are approved for use in triple class exposed RRMM; however, these patients
  • are more likely to be of an advanced age and possess other comorbidities that may result in increased toxicity;
  • are more likely to have been exposed to a BCMA-targeted therapy, which has been found to result in lower response rates;
  • have typically faster rates of disease progression, meaning that CAR T-cells may not be produced in time; and
  • have a high tumor burden and therefore increased risk of cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome.
• Research is currently on the feasibility of CAR T-cell therapy in earlier lines of therapy is ongoing.
• Limited access to therapies as well as the costs associated with treatment are logistical factors when considering CAR T-cell therapy.