Tec-Dara vs. CAR T-Cell Therapy: What To Know
- Options for patients whose multiple myeloma has returned (recurred) or stopped responding to treatment (refractory) are increasing. Two major new treatment options include a combination of the drugs teclistamab and daratumumab, known as Tec-Dara, and CAR T-cell therapy such as cilta-cel (brand name Carvykti).
- Tec-Dara (teclistamab + daratumumab) tends to be more easily available to patients. It is given by injection and showed better responses and longer remissions for patients than older options in clinical trials.
- CAR T-cell therapy is a one-time treatment that can induce durable remissions and was shown to significantly improve survival versus standard therapy. It requires specialized treatment centers and close monitoring for side effects.
- Both treatments target a protein on cancer cells called BCMA.
- When it comes to sequencing, doctors often prefer to give CAR T therapy first so BCMA is not “used up” by Tec-Dara — then introduce Tec-Dara later on if needed.
- Tec-Dara is an excellent alternative for patients who aren’t eligible for CAR T or choose not to undergo the intensive therapy.
“We have two major treatments, the CAR T-cell in early relapsed myeloma that had been approved, and now we have the teclistamab and daratumumab that is approved as well,” Dr. Al-Ola Abdallah, associate professor of hematologic malignancies and cellular therapeutics at University of Kansas Cancer Center, tells SurvivorNet.
Read MoreSame Target, Different Approaches
Tec-Dara is a purely immunotherapy combination given by injection that avoids chemotherapy and, after an initial short corticosteroid taper, is also steroid-free. Beyond its clinical benefits, it can be provided in many community clinics as an outpatient service, allowing more patients to access this technology. In contrast, CAR T is a one-time personalized cell therapy that requires collecting your T cells (immune cells), engineering them in a lab, and then infusing them back into you. This must be done at a specialized center and often requires a short hospital stay.Both approaches target a protein called “BCMA” on myeloma cells, but they work differently.
Daratumumab (an anti-CD38 antibody) not only directly attacks myeloma cells but also awakens the immune system by removing suppressive regulatory T-cells and other inhibitory immune cells. This boost in “killer” CD8+ T-cells makes teclistamab (which bridges T-cells to myeloma via BCMA) even more potent, as the daratumumab has already cleared the way for active T-cells to attack.
How Effective Are These Treatments?
The Tec-Dara combination has shown substantial results in clinical trials. In a large phase III study (MajesTEC-3), Tec-Dara vastly outperformed older standard regimens.
- Three-year progression-free survival (the amount of time patients live without cancer getting worse) was about 83% with Tec-Dara, compared with about 30% with standard therapy
- Complete remission rates were 82% vs 32%
- Survival at three years was 83% vs 65%, favoring Tec-Dara
In other words, Tec-Dara reduced the risk of progression or death by about 83% and cut the risk of death by over half compared to older treatments.
Yet, as Dr. Abdallah notes, doctors tend to recommend CAR T-cell therapy first if possible for strategic reasons.
“If we look at the CAR T-cell as the one-time treatment, if the myeloma comes back again, they are more likely [to] receive a bispecific [like Tec-Dara] and … have a good response,” Dr. Abdallah says. If Tec-Dara is given first, he adds, there’s a chance CAR T-cell therapy will not be possible later on.
Treatment Delivery & Side Effects
Tec-Dara is given by subcutaneous injection (under the skin) once a week or more, typically in the doctor’s office or a clinic. After a couple of weeks of gradually tapering steroids, it’s essentially steroid-free.
The main side effects are infections (often manageable with preventive antibiotics or IVIG) and low-grade cytokine-release syndrome (CRS) or mild neuro effects in a few patients. Importantly, the study reports that no patient on Tec-Dara had very severe (grade ≥3) CRS, and serious neurotoxicity was rare.
CAR T therapy requires hospitalization for the infusion and monitoring. It can cause CRS and neurotoxicity, which can be more severe, but experienced centers now manage these with standard protocols.
The good news is that many patients have only low-grade CRS, but because CAR T is so potent, it requires careful monitoring in a hospital for safety. Because the cells remain in your body, CAR T also carries a risk of prolonged immune effects. Patients need strong support systems, a nearby treatment center, and, usually, a caregiver to monitor them for side effects.
Eligibility And Logistics
Not every patient is a candidate for CAR T. You need to be well enough in terms of organ function and overall fitness. Plus, you need to wait several weeks (often 4-6 weeks) for your cells to be collected and engineered, which can delay treatment.
Some patients may want to delay CAR T for personal reasons (family commitments, travel, etc.). Others may not live near a CAR T center or may have other health issues that exclude them. In those cases, Tec-Dara is a flexible, available option. It’s “off-the-shelf” (which means there’s no need to customize the treatment), can often be started quickly, and can often be given closer to home.
Deciding Between Treatment Approaches
Deciding between these options depends on your individual situation.
Important factors include:
- Disease status and prior therapies: Some patients who were already on daratumumab may not be good candidates for Tec-Dara.
- Health and fitness: CAR T-cell therapy typically requires good performance status and organ function, whereas Tec-Dara is often easier to tolerate.
- Access and logistics: You need to be able to get to a center that offers CAR T-cell therapy. Many patients also need a caregiver. Tec-Dara can often be administered in a local clinic, whereas CAR-T requires a specialized center.
- Patients preferences: CAR T-cell therapy is a one-time intensive treatment that could potentially lead to a long remission, where Tec-Dara is an “off-the-shelf” option that you will need to stay on long-term.
Questions To Ask Your Doctor
- In my case, are there benefits to undergoing CAR T-cell therapy before Tec-Dara or vice versa?
- Am I currently a candidate for CAR T-cell therapy, and if so, how soon could that start?
- If I have Tec-Dara first, how might that affect future use of CAR T?
- What side effects should I expect from each treatment, and how are they managed?
- Are there ongoing clinical trials or other options that might be a good fit for me?
Learn more about SurvivorNet's rigorous medical review process.
