Dr. Siegel on the Importance of Investigating Ide-cel in Multiple Myeloma

David Siegel, MD, PhD, chief, Division of Multiple Myeloma, John Theurer Cancer Center, Hackensack Meridian Health, discusses the importance of investigating idecabtagene vicleucel (Abecma; ide-cel) in patients with relapsed/refractory multiple myeloma.

The phase 2 KarMMa-2 trial (NCT03601078) is a multi-cohort, multi-phase study of ide-cel, the BCMA-directed CAR T-cell therapy, in heavily pretreated patients with high-risk multiple myeloma. Data presented at the 2022 ASH Annual Meeting showed that patients enrolled in cohort C who did not achieve high-level remission with frontline autologous stem cell transplant demonstrated deep and durable responses with ide-cel. Among 31 patients, 74.2% (95% CI, 55.4%-88.1%) experienced a complete response or better, and the overall response rate was 87.1% (95% CI 70.2%-96.4%). Additionally, the median progression-free survival (PFS) was 30.7 months (95% CI, not evaluable [NE]-NE). The 12- and 24- month PFS rates were 90.1% and 83.1%, respectively.

In March 2021, the FDA approved ide-cel for the treatment of patients with relapsed/refractory multiple myeloma after 4 or more prior lines of therapy, including an immunomodulatory agent, a proteasome inhibitor, and an anti-CD38 monoclonal antibody.

As the investigation of ide-cel in multiple myeloma continues, investigators will continue to aim to identify subsets patients who could potentially experience long-term, durable remissions or potentially be cured with CAR T-cell therapy Siegel says. However, understanding who the right patients are to pick remains vital. Thus far, ide-cel has been evaluated more difficult-to-treat patient populations, leading to the hope that these results may translate over to patients who do not have such an aggressive disease type, Siegel adds.

If oncologists can identify particularly susceptible subsets of patients with multiple myeloma, investigators will continue to learn the biomarkers and the disease characteristics of those who have the most durable responses, Siegel continues.

Other T-cell redirecting therapies beyond ide-cel could also affect the treatment paradigm for patients with multiple myeloma, and the hope is to continue to develop beneficial therapies that could lead to durable remissions in subsets of patients, Siegel concludes.