CAR T-Cell Therapy's Role in Multiple Myeloma Treatment
- Multiple myeloma treatment has come a long way and with treatment options like CAR T-cell therapy, doctors are beginning to ask whether long-term remission could start to look like a cure.
- CAR T-cell therapy uses the patient’s own immune system to fight cancer. These T cells are reprogrammed to recognize and attack myeloma, which can lead to deep responses, even after other treatments stop working.
- Some patients are staying cancer-free for years. In studies, a portion of patients have no detectable disease five years after CAR T-cell therapy, raising new questions about whether cure may be possible.
- Right now, doctors are instead using the term “functional cure,” which means there are no signs of cancer and there is no ongoing treatment for a long period.
- CAR T-cell therapy is typically a one-time treatment with the potential for long remissions, but it’s not for everyone. It requires planning, monitoring, and can have serious side effects, so timing and patient selection matter.
“When I first started seeing myeloma patients 25 years ago, the median survival was about five years,” Dr. Melissa Alsina, head of the Multiple Myeloma Transplant Program at Moffitt Cancer Center, tells SurvivorNet.
Read MoreCould CAR T-Cell Therapy Be A Cure?
In some cases, these remissions are lasting longer than anything doctors have seen before. Studies involving one CAR T-cell therapy called cilta-cel have shown that a portion of patients remain alive and without disease five years after treatment, even after their myeloma had returned multiple times before.
“The question came, are those patients cured? And that’s something that we have never heard of … in heavily pretreated relapse myeloma,” Dr. Alsina says.
This has lead to discussions of CAR T as a “functional cure.”
A functional cure means:
- There is no detectable cancer
- The patient is not on ongoing treatment
- The disease does not come back for a very long time
“In theory, definition of cure is that you don’t have any evidence of cancer and you’re not on any treatment,” Dr. Alsina says.
While doctors are still cautious about using the word “cure,” this is the direction the field seems to be moving.
Improving Treatment Outcomes
The progress isn’t just due to CAR T-cell therapy, but also to earlier and more effective treatments for multiple myeloma. Today, many newly diagnosed patients receive a combination of four drugs (often called a “quadruplet”), sometimes followed by a stem cell transplant and maintenance therapy.
These approaches are leading to very deep responses, where even sensitive tests cannot find remaining cancer cells. Patients who reach this level tend to stay in remission longer.
CAR T-cell therapy stands out because it offers the possibility of a treatment-free period. Unlike many myeloma therapies that require ongoing medication, CAR T is typically given once.
After that, many patients can go months or even years without additional treatment.
“Patients get the CAR T … and then they’re doing nothing related to the myeloma. They’re just living their life,” Dr. Alsina explains.
That said, CAR T therapy is not without challenges. It requires a time commitment, including staying near a treatment center for a few weeks, and it can cause side effects such as fever or neurologic symptoms.
Because of this, it may not be the right option for every patient at every stage of disease.
The Future For CAR T-Cell Therapy
Researchers are now working to make CAR T therapies even safer, more accessible, and potentially used earlier in treatment.
The hope is that by combining powerful therapies and using them at the right time, more patients may achieve long-lasting remission, and possibly a functional cure. As Dr. Alsina puts it: “we are feeling really hopeful … about a cure in multiple myeloma.”
Questions To Ask Your Doctor
- Am I a candidate for CAR T-cell therapy?
- Are there less intensive treatment options I should consider instead?
- How will I be monitored after CAR T-cell therapy?
- What are the potential short- and long-term side effects?
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