Dr Berdeja on Patient Factors That Drive Treatment Decisions in Multiple Myeloma

Jesus Berdeja, MD, director, Multiple Myeloma Research, Tennessee Oncology, discusses factors to consider when choosing between CAR T-cell therapy and bispecific antibodies in patients with multiple myeloma.

Bispecific antibodies and CAR T-cell therapies are relatively novel treatment approaches for patients with multiple myeloma, Berdeja says. However, decisions about the optimal sequencing of these therapies, especially in patients who have previously received BCMA-targeted treatments, pose a challenge because of limited data availability, Berdeja notes. Most of the pivotal trials that supported the FDA approvals of the available CAR T-cell therapies and bispecific antibodies in multiple myeloma excluded patients who had received prior BCMA-directed therapies, Berdeja explains. Therefore, real-world evidence and newer studies that allow patients with prior BCMA-targeted treatment may clarify the optimal sequencing of these agents in the future, Berdeja emphasizes. The choice between CAR T-cell therapy and bispecific antibodies largely hinges on individual patient characteristics, the pace of disease progression, and the availability of each therapy, Berdeja explains.

CAR T-cell therapy is a more complex and time-consuming treatment approach than bispecific antibodies, as it involves the collection of T cells and the subsequent manufacturing of CAR T cells, which has a typical turnaround time of approximately 4 to 6 weeks, according to Berdeja. Therefore, patients with rapidly progressing disease may require bridging therapy to control their disease as they await CAR T-cell therapy, Berdeja says. Patients with refractory disease that is rapidly progressing may not be ideal candidates for CAR T-cell therapy because of logistical challenges, Berdeja emphasizes.

Bispecific antibodies are a more convenient option than CAR T-cell therapies, as they are readily available and can be initiated as soon as patients gain insurance approval, Berdeja notes. These agents are particularly suitable for patients with unfavorable disease characteristics, Berdeja explains.

The choice between CAR T-cell therapy and bispecific antibodies does not revolve solely around a patient’s age, according to Berdeja. Although CAR T-cell therapy is often viewed as an aggressive treatment that should not be used in elderly patients, clinical trials have demonstrated positive outcomes with CAR T-cell therapy in older patients, who experience no increased toxicities compared with younger patients who receive this treatment, Berdeja notes. However, patients who are frail or who have significant comorbidities may be vulnerable to the cytokine release syndrome and extensive cytopenias that are associated with CAR T-cell therapy. This population may be better suited for bispecific antibody treatment, Berdeja concludes.

Disclosures: Dr Berdeja reports consulting positions with Bluebird Bio, BMS, Celgene, CRISPR Therapeutics, Janssen, Kite Pharma, Legend Biotech, Pfizer, SecuraBio, and Takeda; as well as grants/research support from 2Seventy Bio, AbbVie, Acetylon, Amgen, Bluebird Bio, BMS, C4 Therapeutics, CARsgen, Cartesian Therapeutics, Celgene, Celularity, CRISPR Therapeutics, EMD Sorono, Fate Therapeutics, Genentech, GSK, Ichnos Sciences, Incyte, Janssen, Karyopharm, Lilly, Novartis, Poseida, Sanofi, Takeda, Teva, and Zentalis.