Dr Oveisi on the Importance of Patient Counseling Prior to CAR T-Cell Therapy in Myeloma

“It's a good idea to counsel patients that [CAR T-cell therapy] is an immune-based treatment, but it doesn't mean that it's free of adverse effects, and it doesn't even mean that it's free from chemotherapy.”

David R. Oveisi, MD, assistant professor, hematology oncology, staff physician, Regenerative Medicine Institute, Cedars-Sinai, discusses the importance of clear communication with patients prior to treatment with CAR T-cell therapy for multiple myeloma.

It is essential for patients to fully understand the process involved in CAR T-cell therapy, Oveisi begins, noting that many patients are surprised to learn that chemotherapy plays a role in this immune-based treatment, which can sometimes deter patients. Clear communication is key; patients need to know that lymphodepleting chemotherapy is necessary to prepare the body for the engineered CAR T cells, he emphasizes. Additionally, they should be aware that adverse effects can arise from both the chemotherapy and the CAR T-cell therapy itself, he notes. The process requires hospitalization and close monitoring, particularly in the initial 30 days post-treatment, Oveisi explains. Understanding a patient’s social circumstances, including their living situation and availability of reliable caregivers, is also crucial to ensuring their safety during recovery, he says.

For community providers treating patients with multiple myeloma, early referral is vital for patients who may benefit from CAR T-cell therapy, Oveisi continues. Patients at high risk for early relapse, either following an autologous transplant or during first-line therapy for transplant-ineligible patients, should ideally be referred before relapse occurs, he says. High-risk relapses are often aggressive and occur over a short period, making early preparation critical, Oveisi emphasizes, noting that establishing contact with a CAR T specialist early allows for necessary groundwork to be completed and the administration of timely treatment when needed.

After transplantation, maintaining consistent follow-up is essential, Oveisi continues. Rather than returning patients to community care entirely, periodic monitoring—at least once or twice a year—can help detect early relapse signs, he states. Collaborative care between transplant specialists and community oncologists fosters a comprehensive approach, enabling timely discussions about treatment options, including transitioning to CAR T-cell therapy before bridging therapy becomes necessary, Oveisi concludes.

Videos

David R. Oveisi, MD, discusses the importance of clear communication with patients prior to administering CAR T-cell therapy for multiple myeloma.

David R. Oveisi, MD, hematologist/oncologist, Cedars-Sinai Medical Center, discusses the evolution and potential role of bispecific antibodies in multiple myeloma, and presents several areas of unmet need regarding their use in this space.

Although the treatment landscape in multiple myeloma has greatly improved in recent years, patients who develop resistant disease still experience poorer outcomes. Bispecific antibodies provide new and promising treatment alternatives for these patients, with an abundance of promising agents coming through the pipeline, Oveisi begins.

Teclistamab-cqyv (Tecvayli) was the first BCMA-/CD3-targeted bispecific antibody to receive 

 in October 2022 for patients with relapsed/refractory multiple myeloma who received at least 4 previous lines of therapy, including a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody, Oveisi reports. The approval was based on findings from the phase 1/2 MajesTEC-1 trial (NCT03145181; NCT04557098), in which teclistamab produced an objective response rate of 61.8%, including a 28.2% complete response rate or better.

Alongside current research, this regulatory decision indicates the efficacy and potency of this class of BCMA-targeted agents in patients with heavily pretreated multiple myeloma, Oveisi says.

However, some patients who previously progressed on CAR T-cell therapy will also experience progression with teclistamab, creating a new unmet need for bispecific antibodies directed at targets other than BCMA, he notes.

Additionally, the role of bispecific antibodies within the current armamentarium is still being determined, although institutional experience has greatly helped efforts to understand optimal sequencing of agents in this space, Oveisi adds.

Lastly, there is significant interest in the long-term administration of bispecific antibodies, Oveisi states. Strategies to feasibly and safely do this without worsening common toxicities such as infection and mitigating risk are still in development, he explains. However, the ability to anticipate, and subsequently mitigate toxicity concerns associated with this drug class continue to improve, Oveisi concludes.

David R. Oveisi, MD, discusses the evolution and potential role of bispecific antibodies in multiple myeloma, and presents several areas of unmet need regarding their use in this space.

David R. Oveisi, MD

Articles

Dr Oveisi on the Importance of Patient Counseling Prior to CAR T-Cell Therapy in Myeloma

Dr Oveisi on the Potential Role of Bispecific Antibodies in Multiple Myeloma