Skip to Navigation Skip to Search Skip to Content
Search All Centers

What Myeloma Options Are Available After CAR T-Cell Therapy?

Read Transcript

Published on January 7, 2020

Key Takeaways

  • Ongoing clinical trials are exploring options for patients after CAR T-cell therapy.
  • Early data looks promising on other targeted therapies.
  • Patients who have relapsed after CAR T-cell therapy continued to express BCMA.

Multiple myeloma experts Dr. Krina Patel and Dr. Sagar Lonial from MD Anderson Cancer Center and Winship Cancer Institute join Patient Power host Jack Aiello to discuss treatment strategy for myeloma patients who have relapsed after CAR T-cell therapy. What options are available? Can CAR T prevent patients from using other treatments? Watch to learn more about research on targeted therapies, clinical trial eligibility and treatment efficacy with novel agents.

This town hall meeting is sponsored by Janssen Biotech, Inc. and Karyopharm Therapeutics with additional support to our partner, Myeloma Crowd (MCR), from Takeda Oncology and Foundation Medicine. These organizations have no editorial control, and Patient Power is solely responsible for the content. It is produced by Patient Power in partnership with The University of Texas MD Anderson Cancer Center.

Featuring

Keep up the great work! You are my go-to source for the latest myeloma news.

— via email

Partners

Myeloma Crowd The University of Texas MD Anderson Cancer Center

You might also like

Transcript | What Myeloma Options Are Available After CAR T-Cell Therapy?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Jack Aiello:                

“Can BiTE therapies be done after CAR-T therapy fails?” Is there any reason to think it can’t?

Dr. Lonial:                 

Yeah. There’s no reason to think it can’t. Loss of BCMA is something that has been reported with CAR-T cells, but at least in our patients that have relapsed, at least all of them have continued to express BCMA. The reason that the myeloma came back was that the T cells didn’t persist long enough.

So, I can’t tell you whether BiTEs will work afterwards because most of these trials say if you’ve had one BCMA-directed therapy, you can’t have another one on a clinical trial. There’s no reason to think why it wouldn’t work because if the target is expressed, you should get activity. I don't know if you’ve had experience differently.

Dr. Patel:                    

Yeah. So, there are more trials now allowing because we’ve asked these questions. So, hopefully, we will have some answers in the next six months. We have had a couple of patients where one didn’t work—let’s say the BiTE didn’t work and they went on to CAR T where it did work or vice versa. So, I think like we said, the antigen is there. It doesn’t make sense that it wouldn’t work. 

I think the other thing is the other antigens that we have besides CS1, there are other new ones that we’re coming up with. Early data, we don’t results yet, but it’s very promising that these antigens are also going to be just on myeloma and not on any major organs.

I think that’s really important for us to find that as a scientific community so that we can use, let’s say, a CAR T with BCMA, then maybe a BiTE with a different antigen, GPR5C, and then maybe ALLO CAR T later if the T cells aren’t working, if you haven’t cured it by then. So, I think we have five years from now, even more options in terms of which order to put it in.

Jack Aiello:                

So, Dr. Patel, let me generalize that question a little bit more—is there any therapy that once you’ve taken the CAR T and if you relapse—and this was actually asked by Cindy—is there any therapy after CAR T that somehow the CAR T would prevent or diminish the effects of using that newer therapy?

Dr. Patel:                    

Not that we know of. So far, we haven’t. I think the other question is right now, we don’t give anything with CAR T. In myeloma, doublets and triplets work better than single agents. The idea of these new cell mods and all those having better immune effects, can we combine that with CAR T to help with persistence of those CAR Ts?

Would daratumamab (Darzalex) maybe help potentially or a CD38 because it does decrease regulatory cells? Will it help with persistence? I think it’s more what can we add to it that’s actually going to make them better rather than precluding having a different treatment afterwards.

Dr. Lonial:                 

I think this has been done in lymphoma, where for instance, patients have relapsed after a CD19 CAR-T cell and been given drugs like pembrolizumab or checkpoint blockade and have re-responded. We’ve certainly anecdotally seen that as well as long as the T cells are persistent, the ability to turn them back on with drugs like pembro or drugs like the pomalidomide (Pomalyst) or lenalidomide (Revlimid) that can reactivate immune function. There may be ways to wake those cells up.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

You might also like