Which CAR-T is the Best for You? Comparing Cilta-cel and Ide-cel

Understanding CAR-T Options for Multiple Myeloma

Ciltacabtagene autoleucel (Carvykti or cilta-cel, marketed by Johnson & Johnson/Legend Biotech) and idecabtagene vicleucel (Abecma or ide-cel, marketed by Bristol Myers Squib) are currently the only two approved CAR T-cell products for myeloma. In addition to their current indication, there are multiple ongoing clinical trials to have these CAR-T therapies moved into earlier use, for example, following diagnosis.

Let us turn our attention to our fellow patients now. At some point in our treatment journey, we may be faced with the question of whether CAR-T treatment may be an option to extend our lives. But, how to choose? First and foremost, we must turn to our myeloma specialist for guidance. He/she will have first-hand knowledge of what is best for a given patient, knowing the patient’s individual health history. 

Comparing Clinical Outcomes: A Retrospective Analysis

Because we can’t compare two different clinical trials that were not designed for that goal, and we don’t have any clinical trials comparing both products, the sources we can use are retrospective analysis. These are a type of study where researchers look back at existing data and analyze different outcomes. For example, they can use the medical records and patient histories from one or more cancer centers to identify patterns, the incidence of a rare side effect, or to compare different treatment strategies. While these studies can provide valuable insights, they rely on previously collected data, which can limit their accuracy and the ability to establish cause-and-effect relationships when compared to prospective studies.

The Journal of Clinical Oncology has recently published a retrospective study comparing the outcomes of a large cohort of patients (386 for Abecma and 255 for Carvykti). The lead author of the study was also the lead of a presentation on the same subject at the most recent annual forum of the American Society of Hematology. The research team published the following results. 

Please note that the information below is using Abecma as a “referent” – in other words, Carvykti results are presented using Abecma as a base that is set to 1.00 (which makes the comparison easier).

Acronyms: AML, acute myeloid leukemia; CR, complete response; CRS, cytokine release syndrome; ICANS, Immune Effector Cell-Associated Neurotoxicity Syndrome; MDS, myelodysplastic syndrome; ORR, overall response rate 

Key Differences Between Carvykti and Abecma

The authors summarize their conclusions for this comparison:

• A higher number of patients showed a response to Carvykti, including a higher complete response rate when compared to Abecma. This advantage was also seen in different patient subgroups, such as those with extramedullary disease, high-risk cytogenetics, prior exposure to BCMA-therapy, or older age. Higher response rates also translated into longer survival outcomes.
• Patients treated with Carvykti also experienced higher rates of certain side effects and toxicities, including severe CRS, delayed neurotoxicities, and infections. Researchers also reported a trend towards higher incidence of secondary malignancies.
• There were no differences in other toxicity rates and non-relapse mortality.

Making an Informed Treatment Decision

As mentioned earlier, please talk to your myeloma specialist! It's important to stay updated on new therapies, especially CAR T-cell treatments. While promising, ongoing studies are still revealing how to use these therapies effectively and who may benefit the most.

If you have any questions or concerns about the latest data, don’t hesitate to discuss them with your medical team. Each situation is unique, and considering factors like previous treatments and other health conditions is vital in choosing the best strategy for you. 

Stay informed, as it can help you engage in meaningful conversations about your treatment options. Click below to keep reading the latest treatment advances in myeloma:

NEWS