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Who Is CAR T-Cell Therapy Right For?

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Published on March 10, 2020

Key Takeaways

  • People who aren’t good candidates for CAR T-cell therapy are those who've had a lot of prior therapies and therefore don’t have enough T cells to be used in this therapy.
  • There are many CAR T-cell clinical trials going on. Many companies are developing new CAR-T cells that differ from one another, so it will take some time to discover which is most effective.
  • Doctors are studying if CAR T-cell therapy is more effective at the start of treatment when the immune system and cells are healthier. Patients who would benefit from early treatment are those who relapse early after a stem cell transplant and high-risk patients.  

Multiple myeloma experts Dr. Dan Vogl, from the University of Pennsylvania’s Abramson Cancer Center, and Dr. Frits van Rhee, from the University of Arkansas for Medical Sciences Myeloma Center, explain which patients could benefit the most from CAR T-cell therapy and who it is not right for. Watch to find out more about the data clinicians currently have and the ongoing research using this type of immunotherapy to treat myeloma.

This program is sponsored by GSK. This organization has no editorial control. It is produced by Patient Power. Patient Power is solely responsible for program content.

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Transcript | Who Is CAR T-Cell Therapy Right For?

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.

Andrew Schorr:           

Hello, I am Andrew Schorr with Patient Power, and we are in Orlando, Florida for this live Myeloma Ask the Expert program 

Let me introduce our guests, so two wonderful guests: immediately to my right is Dr. Frits van Rhee, he is the Director of the Myeloma Program at the University of Arkansas Medical Sciences in Little Rock. Did I get it right?

Dr. van Rhee:              

You got it right, thank you. 

Andrew Schorr:           

Okay, thank you. And to his right is Dr. Dan Vogl who is a myeloma specialist at the University of Pennsylvania, Penn Medicine. Thank you both for being with us. I should mention that Dr. Vogl is also the specialist who treats our dear friend Cindy Chmielewski, many people know, Myeloma Teacher on the Internet. And fortunately, I have to say Cindy’s doing well, so we’re really delighted. Okay, gentlemen, are you ready for some questions from the patients?

Dr. van Rhee and Dr. Vogl:       

Yes.

Andrew Schorr:           

Your institution was really on the ground floor of CAR T, it’s approved in some lymphoma areas, but not in myeloma chimeric antigen receptor T-cell therapy. We and people in the myeloma community, know people who have been treated this way, and some are doing well; and some not, and quite frankly, some people have passed on. 

So, the question is, and you were talking about this in smoldering myeloma: do we know, Dr. Vogl, who might be a candidate? For people who have not done well or progressed through other therapies, now you say, “Was CAR T an option?” is there like a blood test you can do and say, “This is going to work for you,” and “No, this is not right for you.”

Dr. Vogl:                      

Well, so I think there are actually a couple of answers to that question. There are some people for whom doing CAR T-cell therapy is clearly not an option, primarily people who have been through a lot of prior therapies who don’t have enough T cells in their blood that we can effectively collect them, manufacture them outside the body to be able to give them back as a T-cell therapy. And so, we do know some of our patients just right off the bat, that isn’t going to be a useful approach.

But the bigger question of who’s going to benefit the most from CAR T-cell therapy, we’re really only just beginning to figure out, because we’re still very early in our trials of CAR T-cell therapies, and there are a lot of different CAR T-cell therapies out there, there are least six or seven companies—and probably many more by now—developing new CAR-T cells, all of them are a little bit different from each otherAnd it’s going to take a long time to figure out which ones are the most effective, and which patients are the most effective.

And probably one of the biggest directions for the field is starting to answer the question: will they actually work much better if we give them earlier in the course of the disease when people’s immune system is healthier, when their T cells are healthier, and therefore, maybe better able to take advantage of training those T cells to kill the myeloma cells. And so, I think that’s going to be the next wave of trials, is actually doing CAR T-cell therapy as the second—or maybe for especially high-risk patients as part of their first line of treatment to see if that can actually provide the cure that we keep hoping we’ll get for myeloma.

Andrew Schorr:           

Is this a similar discussion to what you had over many years about stem cell transplant, or double transplant? In other words, who is it right for, and when are they physically fit, is their immune system—you know, whatever, is it similar to that?

Dr. Vogl:                      

So, I think it has a lot of similarities, and CAR-T cells do come with some real potential risks, there are some serious immune-related side effects that people can get, and I would never want to underplay the potential risks of CAR-T cells. But at the same time, if you compare it to stem cell transplantsI’ve been impressed at how much better-tolerated in many ways the CAR T-cell therapy is because it doesn’t have that really high dose of chemotherapy, it doesn’t depend on a very high dose of chemotherapy for its effectiveness.

And so, patients make it through CAR-T cells, some with some potentially serious side effects, others with more mild side effects; but overall, doing reasonably well. And the biggest question is, can we make it work even better so that the responses at least last as long as you get from a stem cell transplant, or maybe even lead to cures.

Andrew Schorr:           

Okay.

Dr. van Rhee:              

So, if I may answer that too, I think Dr. Vogl is absolutely correct. I think there are two obvious patient groups who are candidates for early CAR T-cell intervention: patients who relapse early after a stem cell transplant; and then, there are these high-risk patients. And I think in all myeloma centers, we struggle with these patients, because they more or less have a binary outcome: they either are going to do well, and their disease does not come back; or they have early relapses, and they’re very difficult to manage. And nobody really has an answer for this with the current available treatment kit. So, CAR-T cells are very interesting in that regard.

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.

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