Future Indications and Frontline Potential of Cilta-Cel in Multiple Myeloma: Insights From Dr Binod Dhakal


In the final part of our interview with Binod Dhakal, MD, lead investigator of the CARTITUDE-4 study, he looks to the future of earlier treatment for relapsed/refractory multiple myeloma.

In the final part of our interview with Binod Dhakal, MD, lead investigator of the CARTITUDE-4 study, whose data were used as the basis of the FDA’s approval of ciltacabtogene autoleucel (cilta-cel [Carvykti]; Janssen/Johnson & Johnson and Legend Biotech), he looks to the future of earlier treatment for relapsed/refractory multiple myeloma (MM).

Dhakal is an associate professor in the Division of Hematology and Oncology at Medical College of Wisconsin. CARTITUDE-4 investigated use of cilta-cel in patients with who have received at least 1 prior line of therapy.


What are some potential future indications of cilta-cel in the MM treatment landscape?

Right now, just looking at CARTITUDE-4, we just had a 16-month follow up, so we continue to look longer on these patients in the study to better understand the long-term efficacy and safety profile of Carvykti this patient population. We're also currently performing deeper analysis of data from the study, and we just presented the data about the health-related quality of life of the Carvykti patients in CARTITUDE-4, and we saw that this really can impact the quality of life in patients compared with standard of care.

In addition to that, Carvykti, or cilta-cel, is also being investigated as a treatment option in frontline therapy. There are 2 ongoing studies right now. One is CARTITUDE-5, which is a randomized phase 3 study that is trying to investigate the safety and efficacy of cilta-cel compared to patients who received the standard of care who had no immediate upfront intent for bone marrow transplant. CARTITUDE-6 is another important study, which is trying to assess the safety and efficacy of CAR T [chimeric antigen receptor T-cell therapy] vs standard of care, which is stem cell transplant in transplant-eligible patients.

I think those 2 studies are going to be very, very important to tell us the role and the significance of this product and the construct in the myeloma patients.

Is multiple myeloma a curable disease?

Unfortunately, no. It is still an incurable cancer. But what we are seeing is that if you look at the median age of myeloma patients, they're about 69 to 70 years of age. So what we're seeing with these newer therapies—including not only Carvykti, but the other therapies that have been approved in the last 10 years or so—they have really changed the outlook of these patients and there are a lot of patients who are living much longer than they used to. So I think this is really very exciting time, with the approval of the drugs like Carvykti and other treatments.

I think combining this and trying to kind of use them earlier, I think we're probably going to, I don’t want to say have a cure, but of course that is our goal. But a lot of patients, a majority of patients, will have the benefit of having long-term disease control. Even though it's not curable right now, I think with all these tools, it's quite possible we might achieve cure in some subsets of patients.

I just want to highlight the results of CARTITUDE-4 and the recent approval, why it is very significant, because CARTITUDE-4 showed that cilta-cel in early lines of treatment, we saw the deep and durable efficacy responses, with the significant improvement in progression-free survival, with the hazard ratio that impressive, and also the manageable safety profile. We hope to have in the real world the patients really derive benefit with this using early lines of therapy.

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