Dr Mewawalla on the Real-World Roles of Cilta-Cel and Ide-Cel in R/R Myeloma

“[The April 2024 FDA approvals of cilta-cel and ide-cel] moved CAR T-cell therapy into earlier lines. In earlier lines, patients have better T cell fitness, and their diseases are also better controlled. Therefore, this is going to redefine the standard of care at first relapse for high-risk patients [with multiple myeloma].”

Prerna Mewawalla, MD, medical director of Apheresis and a hematologist-oncologist in the Division of Hematology and Cellular Therapy at Allegheny Health Network, as well as an associate professor at the Drexel University College of Medicine, explained what the April 2024 FDA approvals of ciltacabtagene autoleucel (cilta-cel; Carvykti) and idecabtagene vicleucel (ide-cel; Abecma) for the treatment of relapsed/refractory multiple myeloma now mean for clinical practice.

In April 2024, the FDA approved cilta-cel for the treatment of patients with relapsed/refractory multiple myeloma who were treated with at least 1 prior line of therapy, which included a proteasome inhibitor (PI), an immunomodulatory agent (IMiD), and who are refractory to lenalidomide (Revlimid). The same day, the FDA also approved ide-cel for the treatment of patients with relapsed/refractory multiple myeloma who previously received at least 2 therapies, including a PI, IMiD, and an anti-CD38 monoclonal antibody.

Previously, CAR T-cell therapies were options in later lines of therapy, with both ide-cel and cilta-cel initially approved after 4 or more prior treatment lines; however, these 2 expanded approvals shifted the narrative, and CAR T-cell therapies are no longer the last option for patients with relapsed/refractory multiple myeloma, Mewawalla began. With cilta-cel and ide-cel now indicated in earlier lines of therapy, patients at this stage in treatment tend to have better T-cell fitness, and their disease is more controlled, she explained. Although this is still new in clinical practice, she noted that this could help redefine the standard of care for high-risk patients at first relapse. Additionally, it promotes reevaluation of post–CAR T-cell therapy strategies, as it has historically been used in later lines, she added. As CAR T-cell therapy is used in earlier lines of therapy, it’s important to consider what treatments are available as subsequent treatment, Mewawalla concluded.