Dr Phull on the Efficacy and Safety of Cilta-Cel vs Ide-Cel in R/R Multiple Myeloma

“Comparing across trials we see clearly that ciltacabtagene autoleucel seems to have superior response rates as well as more durable responses, and that was also seen in our real-world analysis.”

Pooja Phull, MD, hematologist/oncologist, John Theurer Cancer Center, Hackensack University Medical Center, discusses findings from a retrospective, real-world analysis comparing the efficacy and safety of ciltacabtagene autoleucel (cilta-cel; Carvykti) and idecabtagene vicleucel (ide-cel; Abecma) in patients with relapsed/refractory (R/R) multiple myeloma.

The analysis included 114 patients, with 50 receiving ide-cel and 64 receiving cilta-cel. The overall response rate (ORR) was significantly higher with cilta-cel vs ide-cel, at 86% vs 60%, respectively (P = .002). Additionally, median progression-free survival (PFS) was not reached (NR) with cilta-cel vs 7.5 months with ide-cel (P < .0001). Overall survival (OS) was NR in either group (P = .12). Extramedullary disease was associated with worse PFS overall (4.1 vs 21.4 months; P < .0001) and OS (6.2 months vs NR; P < .0001).

A univariate analysis confirmed cilta-cel treatment (HR, 0.28; 95% CI, 0.14-0.54; P < .001) as favorable and extramedullary disease (HR, 4.3; 95% CI, 2.3-7.9; P < .001) as unfavorable prognostic factors.

Safety profiles were comparable. Any-grade cytokine release syndrome (CRS) occurred in 82.2% of ide-cel-treated patients vs 67.2% of cilta-cel-treated patients (P = .08), with grade 3 or greater CRS occurring in 2.2% and 0% of patients, respectively (P = .2). Immune effector cell–associated neurotoxicity syndrome (ICANS) was observed in 11.1% of ide-cel-treated patients and 12.1% of cilta-cel-treated patients (P = .8), with grade 3 or greater ICANS occurring in 2.2% and 3.5%, respectively (P = .7).

Phull concludes that cilta-cel demonstrated superior ORR and PFS compared with ide-cel, but patient selection influenced outcomes. Ide-cel was frequently chosen for older, frailer patients with greater comorbidities, including higher rates of extramedullary disease.