Dr. Martin on the Utility of CAR T-Cell Therapy in Late Relapsed Multiple Myeloma

Thomas G. Martin, MD, clinical professor of medicine, Adult Leukemia and Bone Marrow Transplantation Program, associate director, Myeloma Program, University of California San Francisco (UCSF), co-leader, Cancer Immunology & Immunotherapy Program, UCSF Helen Diller Family Comprehensive Cancer Center, discusses the utility of CAR T-cell therapy in late relapsed multiple myeloma. 

In the late-relapse setting, several factors, such as performance status, need to be taken into consideration when selecting treatment for patients, Martin explains. Although CAR T-cell therapy is the preferred treatment for patients with heavily pretreated disease, patients must be young and mobile with a good performance status to be eligible for CAR T-cell therapy. Older or unfit patients may not get through CAR T-cell therapy without significant toxicity, Martin adds.

Accessibility is another challenge with CAR T-cell therapy because the treatment needs to be manufactured and patients need to remain near 1 of the 70 centers that can administer CAR T-cell therapy for upward of 1 month, Martin says. In turn, patients are faced with potentially treatment-limiting financial expenses.

For patients with late-relapse disease who cannot undergo CAR T-cell therapy, treatment with melphalan flufenamide (Pepaxto; melflufen), belantamab mafodotin-blmf (Blenrep), or selinexor (Xpovio) may be considered, Martin concludes.

* Editor's note: This interview was conducted prior to the Oncopeptides' decision on October 22, 2021 to withdraw the indication of melphalan flufenamide in combination with dexamethasone in select adult patients with relapsed/refractory multiple myeloma from the US market.