CAR T-Cell Therapy May Be Moving Up in Myeloma Treatment Sequencing

The conversation around sequencing for multiple myeloma is still a work in progress, according to bone marrow transplant specialist Nick Barkemeyer, PA-C, MMS, of the Centennial Center for Blood Cancers Clinic in Nashville, Tennessee. However, CAR T-cell therapies are emerging sooner as confidence around their use grows among providers.

In an interview following a Community Case Forum with Oncology Nursing News, Barkemeyer, who moderated the discussion with his peer oncology advanced practice providers, emphasized that CAR T-cell therapy provides a strong and effective option for multiple myeloma following bone marrow transplant.

While patients and providers alike may harbor hesitation, whether due to unfamiliarity with the treatment type or worries that it may be too strong to start with compared with more traditional cancer treatment options, CAR T-cell therapy is becoming a more immediate line of therapy in many cases.

As Barkemeyer pointed out, variation in sequencing may also have to do with the type of clinic at which patients are treated. For instance, providers at specialized clinics such as the one where Barkemeyer works, are more likely to have experience with CAR T-cell therapies and may be more likely to recommend it for a patient than providers who work at a community clinic.

Transcript

We’re bringing [CAR T-cell therapy] into the conversation much earlier now than we used to, especially with the second-line indication for [ciltacabtagene autoleucel; Carvykti]. We’re already sprinkling those thoughts in, even probably before we do transplant. We say, “We’re going to go through transplant, we’re going to do our maintenance after the fact, and then hopefully we can get a nice, long response with transplant. But just know that this is probably our next option going forward here, if and when relapse does occur.”

We [at the Centennial Center for Blood Cancers Clinic] are starting to implement [CAR T-cell therapies] much sooner, being the type of facility that is heavily involved in the research, and we’re the referring center for the community. We’re doing these conversations much sooner, compared with some places where they may be a little bit less familiar with it, and they might still believe, “Oh, this is something that we can use later on down the road.”

I even mentioned this in the program. Some of your savvier patients will make an argument such as, “I want to do all my traditional options first before I consider an immunotherapy like CAR T-cell therapy because that seems like it’s a really good option, but I don’t want to use it up too soon.”

The community really hasn’t gotten a firm grasp on what the sequencing is with everything. We still like to opt for transplant first. But then once that occurs, it’s like, “What do we do next? Do we do traditional [chemotherapy] and then do CAR T-cell therapy? Do we go right into CAR T-cell therapy? Do we try to do everything else, like a bispecific, before we do a CAR T-cell therapy? Do we do bispecifics after CAR T-cell therapy?” It’s still being discussed and talked about in the multiple myeloma community.

This transcript has been edited for clarity and conciseness.