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CAR T cells in multiple myeloma: lessons learned

The question of whether chimeric antigen receptor (CAR) T cell therapies should be used in earlier lines (after 1–2 prior lines of therapy) in patients with relapsed and/or refractory multiple myeloma remains unanswered. Herein, I argue that the use of surrogate end points that lack a robust correlation with overall survival, as well as suboptimal control arms and use of post-progression therapies, limit the ability to make definitive conclusions on the basis of the available data.

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References

  1. US Food and Drug Administration. March 15, 2024: Meeting of the Oncologic Drugs Advisory Committee Meeting Announcement. fda.gov, https://www.fda.gov/advisory-committees/advisory-committee-calendar/march-15-2024-meeting-oncologic-drugs-advisory-committee-meeting-announcement-03152024 (accessed 19 March 2024).

  2. Sokolic, R. Oncologic Drugs Advisory Committee Meeting Introductory Comments. Ciltacabtagene Autoleucel. fda.org, https://www.fda.gov/media/177057/download (2024).

  3. Sokolic, R. Oncologic Drugs Advisory Committee Meeting Introductory Comments. Idecabtagene Vicleucel (ide-cel). fda.gov, https://www.fda.gov/media/177060/download (2024).

  4. Olivier, T., Haslam, A. & Prasad, V. Reporting of physicians’ or investigators’ choice of treatment in oncology randomized clinical trials. JAMA Netw. Open 5, e2144770 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  5. ODAC. March 15, 2024 Oncologic Drugs Advisory Committe Meeting. fdazoomgov.com, https://go.nature.com/4baYsLo (2024).

  6. Olivier, T., Haslam, A. & Prasad, V. Post-progression treatment in cancer randomized trials: a cross-sectional study of trials leading to FDA approval and published trials between 2018 and 2020. BMC Cancer 23, 448 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  7. Mohyuddin, G. R. et al. Intention to treat versus modified intention-to-treat analysis in B-cell maturation antigen and CD19 chimeric antigen receptor trials: a systematic review and meta-analysis. Eur. J. Cancer 156, 164–174 (2021).

    Article  CAS  PubMed  Google Scholar 

  8. Hernandez, I., Prasad, V. & Gellad, W. F. Total costs of chimeric antigen receptor T-cell immunotherapy. JAMA Oncol. 4, 994–996 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  9. Centers for Medicare & Medicaid Services. National Coverage Determination. Chimeric Antigen Receptor (CAR) T-cell therapy. 110.24. cms.gov, https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=374 (accessed 22 April 2024).

  10. Centers for Medicare & Medicaid Services. National Coverage Determination Process & Timeline. cms.gov, https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/coverage/national-coverage-determination-process-timeline (accessed 19 March 2024).

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Correspondence to Vinay Prasad.

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V.P. has acted as a consultant of OptumRX and UnitedHealthcare, receives research funding from Arnold Ventures through a grant made to UCSF, receives royalties for books and writing from Free Press, Johns Hopkins Press and MedPage and hosts the podcasts, Plenary Session, Sensible Medicine and VPZD, writes the newsletters Sensible Medicine, the Drug Development Letter and VP’s Observations and Thoughts, and runs the YouTube channel Vinay Prasad MD MPH, which collectively earn revenue on the platforms Patreon, Substack and YouTube.

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Prasad, V. CAR T cells in multiple myeloma: lessons learned. Nat Rev Clin Oncol (2024). https://doi.org/10.1038/s41571-024-00898-8

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