Progress in CAR-T Cell Therapy for Myeloma: What Does the Future Hold?

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Jack Aiello:

Brad wrote the question online. He says, do you think CAR-T therapies will be available to patients in the near future?  If so, will there be any restrictions or contraindications to who might be a candidate for that type of therapy, and would a patient still have to be on chemo after this type of therapy?  

Dr. Fonseca:

So we can start with the last one.  Our hope is that as patients complete CAR-T cells they can be off chemotherapy.  CAR-T cells are in diapers right now.  The early set of results are very, very promising. We have seen clinical trials from multiple places, various companies, the NCI, the University of Pennsylvania and China, and they all show a high level of activity.  My sincere hope is that within the next couple of years we have commercial CAR-T cells, meaning any doctor can write an order, a prescription that will get a patient into CAR-T cells.  

I desperately think they are needed.  I hope that as we get them and as we start using them we'll get better about understanding the toxicities and how to manage them and when to use them.  In theory, they could potentially be done even in a larger population than the transplanted cell, but there might be a situation where someone is very sick with other conditions, with a heart condition or a pulmonary condition, where it may not be necessarily the safest thing. 

But I think people are going to try to push the envelope with this, because as they are being used right now it's more of a rescue strategy.  Now, stay tuned.  It may be that five years from now CAR-T cells are part of the up-front therapy, maybe even instead of the stem cell transplant.  

Jack Aiello:

Do you think it becomes maybe a curative strategy when used earlier?  

Dr. Fonseca:

Well, I think people spend a lot of time debating whether myeloma is curable or not, and that's because they don't define exactly what that means, but I do think that some patients will have very long-lasting remissions, and our hope will be that like everyone else we'll be able to carry on our lives and complete it when our time comes but not because of myeloma being the reason for that completion.  So the short answer is yes.  

I think there are some patients that will be cured from this.  The reality is some patients that go through stem cell transplant right now, it's a small minority, but there are patients who go through stem cell transplant, who we see in our clinics and are 15 and 20 and 25 years later and still doing very well.  

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.