CAR-T Therapy For Multiple Myeloma: A Challenging Yet Promising Path
CAR-T Therapy For Multiple Myeloma: A Challenging Yet Promising Path
In the not-too-distant future, CAR-T cell therapy products for multiple myeloma will gradually be launched and quickly enter the clinic, which is good news. However, we still face many pressing real-world problems that need to be addressed.
Challenges Faced by CAR-T Therapy
Firstly, CAR-T therapy is expensive
After the launch of CAR-T products, their high prices have deterred some patients. According to conservative estimates, each CAR-T cell therapy treatment may cost no less than $400,000. Legend Biotech’s CAR-T product (Ciltacabtagene Autoleucel, Carvykti) has already been launched in the United States, currently priced at $465,000; BMS and Bluebird Bio’s CAR-T therapy Abecma was approved in March 2021, priced at $415,000.
Secondly, CAR-T therapy is not a cure
While CAR-T therapy is indeed effective in treating multiple myeloma, it does not equate to a cure. Almost all patients still face the risk of relapse and progression. Therefore, even if CAR-T therapy becomes widespread, it is not the ultimate treatment for multiple myeloma, and close monitoring of the disease is still required after treatment.
Thirdly, sequential therapy after CAR-T treatment
After CAR-T therapy, the optimal sequential treatment is currently unclear. Since a cure cannot be achieved, sequential drug therapy should be considered after treatment to not only avoid impairing the function of CAR-T cells in the body but also, ideally, enhance the efficacy of CAR-T cells, increase the anti-tumor effect, and achieve sustained disease control.
Fourthly, patients with extramedullary disease cannot directly benefit from CAR-T therapy
Numerous data have shown that multiple myeloma patients with extramedullary disease cannot directly achieve sustained remission from CAR-T treatment. Even if effective, progression is likely to occur. Therefore, refractory patients with extramedullary disease should consider CAR-T therapy sequentially after effectively controlling the extramedullary disease with chemotherapy.
Fifthly, CAR-T therapy is used in later treatment lines
Currently, CAR-T therapy for multiple myeloma is more strongly supported for use in patients with at least triple-refractory relapsed/refractory disease. Insufficient data currently exist to support the first-line use of CAR-T therapy for multiple myeloma. Some centers are attempting to use CAR-T therapy sequentially after first-line autologous stem cell transplantation in high-risk patients, and preliminary results have shown good clinical efficacy and safety. However, we still await more data to confirm the feasibility of CAR-T therapy in first-line treatment—firstly, the issue of exorbitant costs must be addressed.
Despite these challenges, the advent of CAR-T products has brought a glimmer of hope for multiple myeloma patients with relapsed, multi-refractory disease. Although the difficulties are numerous, I believe that with the “intensive competition” among various products and effective coverage by commercial insurance, the price issue may only be a matter of time.
Furthermore, real-world data have shown that some refractory patients who receive CAR-T cell therapy can still exhibit a decent treatment response upon disease relapse or progression. In other words, progression after CAR-T therapy is not overly concerning.
Standardized Diagnosis and Treatment
We have been promoting “standardized diagnosis and treatment,” which not only benefits sustained disease control but also effectively reduces medical expenses for patients. A few days ago, we proposed “using every effective treatment to its fullest extent,” which is also an important part of “standardized diagnosis and treatment.” We all know that many new drugs are not immediately covered by medical insurance, and CAR-T therapy is unlikely to be covered by medical insurance in the short term. Since the treatment of multiple myeloma is a prolonged battle, standardized diagnosis and treatment allows us, as multiple myeloma patients, to ensure maximum efficacy while strategically saving costs.
We have also been strongly promoting first-line autologous stem cell transplantation for the treatment of multiple myeloma, as the position of autologous transplantation has not been shaken by any new drugs—even CAR-T therapy will not be able to shake the role of autologous transplantation in the short term. Whether it is new drug therapy, autologous transplantation, or CAR-T therapy, they are all part of the treatment for multiple myeloma. Optimizing the treatment strategy is our important task for the foreseeable future.
By objectively, calmly, and rationally understanding CAR-T therapy, we can better apply CAR-T cell therapy to the most suitable group of multiple myeloma patients. We will continue to closely monitor each CAR-T product as it is launched.
Welcome CAR-T therapy! Although the road ahead is full of thorns and rough terrain, we remain confident.
Another reminder: All multiple myeloma patients should pay attention to standardized diagnosis and treatment, as well as standardized follow-up. Multiple myeloma patients suitable for transplantation should undergo first-line autologous stem cell transplantation, with high-risk patients recommended for sequential autologous transplantation. Remember, complete remission does not equal a cure.