Dr Banerjee on Nivolumab Use After CAR T-Cell Therapy Progression in Myeloma and NHL

Rahul Banerjee, MD, FACP, assistant professor, Clinical Research Division, Fred Hutchinson Cancer Center; assistant professor, Division of Hematology and Oncology, University of Washington, discusses findings from a phase 2 trial of nivolumab (Opdivo) in patients with multiple myeloma or non-Hodgkin lymphoma (NHL) who have progressed on prior CAR T-cell therapy, which he presented at the 2024 Transplantation & Cellular Therapy Meetings.

The efficacy of nivolumab was limited across both patient cohorts in the trial, and investigators are still unsure of the exact patient populations in which this agent may be most effective post–CAR T-cell therapy, Banerjee says. Investigators hypothesized that checkpoint inhibition with nivolumab would improve T-cell effector function following progression on CAR T-cell therapy in patients with NHL and multiple myeloma, Banerjee notes. However, only 1 patient in the NHL population (n = 9) experienced a response, translating to an overall response rate (ORR) of 11%. This finding is similar to previous reports with nivolumab in patients with NHL, Banerjee explains.

Among the patients in the myeloma cohort (n = 11), 2 responded to nivolumab, translating to an 18% ORR. Although this response rate is descriptively higher than those seen with the agent in previous myeloma studies, investigators are unsure whether it is indicative of a unique aspect of this research, Banerjee emphasizes. Additional correlative studies are being conducted to determine why most patients with myeloma did not respond to nivolumab, according to Banerjee.

Although responses achieved by patients in the myeloma cohort were rapid, investigators have not yet determined the reason for these rapid responses, Banerjee adds. Nivolumab may have engaged the patients’ T cells, or it may have directly attacked myeloma cells alone or in conjunction with native T cells, Banerjee says.

Overall, although nivolumab may be an effective treatment option for certain patients with NHL or multiple myeloma, further research is necessary to confirm its benefit in select patient subsets, Banerjee explains. Other research presented at the 2024 Transplantation & Cellular Therapy Meetings may showcase alternative treatment options for patients with myeloma or lymphoma who have relapsed after CAR T-cell therapy, Banerjee concludes.