Ajai Chari, MD

Panelists discuss how UCSF Health has learned that successful integration of CAR T-cell therapy in multiple myeloma requires multidisciplinary collaboration, patient selection optimization, and management of toxicities. Future research includes exploring CAR T-cell therapy in earlier treatment lines and combining it with novel agents to enhance efficacy.

Panelists discuss collaborating with community practices on CAR T-cell therapy for multiple myeloma through joint clinical trials, patient education programs, and shared data initiatives. These partnerships enhance treatment access, foster innovation, and improve patient outcomes across diverse settings.

Panelists discuss how challenges in the CAR T referral process include delayed referrals, patient logistics, and managing expectations. One institution addresses these through streamlined communication, patient education, and clear referral guidelines. Community physicians should refer early on, ensure candidacy, and collaborate closely to optimize outcomes.

Panelists discuss how, a collaborative approach to co-managing and co-monitoring patients receiving CAR-TCAR T-cell therapy patients, ensuring continuity of care as they transition to community settings. We They employ detailed care plans, electronic health records integration, and regular follow-ups with community providers to facilitate seamless transitions.

Panelists discuss how CAR T-cell therapy involves engineering a patient’s T cells to target cancer cells. The process includes cell collection, genetic modification, expansion, and reinfusion and streamlines the process with integrated workflows. Bridging therapy is provided in-house to treat patients awaiting CAR-T infusion.

Panelists discuss how the typical CAR T-cell therapy referral process begins with community physicians contacting the treatment center. The patient undergoes a thorough evaluation, including medical history, eligibility criteria, and pretreatment assessments before final selection for therapy.

Panelists discuss how, when considering earlier lines of CAR T-cell therapy for relapsed/refractory multiple myeloma, key institutional factors include patient fitness/age, cytogenetic risk status, prior therapy response duration, and BCMA expression levels. Manufacturing timelines, financial considerations, and center-specific outcomes data also influence timing decisions. For patients receiving early-line CAR T therapy, subsequent treatment options typically focus on novel agent combinations or clinical trials exploring additional cellular therapies, with choices guided by response duration to CAR T and the patient’s individual disease characteristics and treatment goals.

Panelists discuss how, for second-line treatment of relapsed/refractory multiple myeloma (R/R MM), patients suitable for CAR T-cell (cilta-cel vs ide-cel) therapy typically have a poor prognosis with limited response to prior therapies. Institutional guidelines focus on factors such as prior lines of therapy, organ function, and cytogenetics. Non-medical factors, such as geographic access and financial constraints, also influence CAR T-cell therapy referral eligibility.

Panelists discuss how chimeric antigen receptor (CAR) T-cell therapy in early relapsed multiple myeloma can provide deep and durable responses for eligible patients, though patient selection, timing of referral, manufacturing logistics, and management of adverse effects remain important considerations in optimizing outcomes.

Panelists discuss how community centers can effectively implement bispecific antibody therapy for patients with relapsed/refractory multiple myeloma, addressing challenges such as staff training, patient monitoring, and managing potential adverse events in a non-academic setting.

Panelists discuss how the CEPHEUS trial’s demonstration of improved progression-free survival with daratumumab-VRd versus VRd alone in transplant not-preferred NDMM provides compelling evidence for quadruplet therapy in this setting, though considerations of cost, toxicity management, and patient selection remain important factors in implementation.

Panelists discuss how to approach treatment decisions and management strategies for a 58-year-old woman with relapsed/refractory multiple myeloma who is post-autologous stem cell transplant, MRD-negative, and currently receiving bispecific antibody therapy, considering factors such as prior treatments, response duration, and long-term treatment goals.

Panelists discuss how optimizing dosing intervals and carefully considering combination strategies for bispecific antibodies in relapsed/refractory multiple myeloma could enhance treatment efficacy while managing toxicities and improving patient quality of life.

Panelists discuss how recent clinical trials have demonstrated improved outcomes with antibody-containing regimens and biomarker-driven approaches in patients with transplant not-preferred newly diagnosed multiple myeloma (NDMM).

Panelists discuss how the optimal sequencing of bispecific antibodies and CAR T-cell therapies in relapsed/refractory multiple myeloma could maximize treatment efficacy and improve patient outcomes in this challenging disease setting.

Panelists discuss how the OPTec study, which explores outpatient step-up administration of teclistamab, could impact real-world practice by potentially improving patient convenience and reducing healthcare resource utilization in the treatment of multiple myeloma.

Panelists discuss how the decision between quadruplet versus triplet therapy depends on multiple factors, including cytogenetic risk status, insurance coverage/drug access, patient fitness to tolerate additional toxicity, and the strength of evidence supporting improved outcomes with 4-drug combinations.

Panelists discuss how prophylactic use of tocilizumab in the MajesTEC-1 trial may reduce the incidence and severity of cytokine release syndrome (CRS) in patients receiving bispecific antibody therapy for multiple myeloma, potentially improving treatment safety and tolerability.

Panelists discuss how the follow-up results from the RedirecTT-1 study provide insights into the long-term efficacy and safety of bispecific antibody combinations in treating relapsed/refractory multiple myeloma, potentially shaping future treatment approaches for this challenging disease.

Panelists discuss how patient-specific factors like age, comorbidities, cytogenetic risk status, and personal preferences guide decisions to deviate from standard protocols, with particular attention to frailty scores and organ function when considering treatment intensity.

Panelists discuss how the TRIMM-2 study explores the potential of combining bispecific antibodies to enhance treatment efficacy in patients with relapsed/refractory multiple myeloma, potentially offering a novel therapeutic strategy for this difficult-to-treat condition.

Panelists discuss how Talquetamab, a novel GPRC5DxCD3 bispecific antibody, shows promising results in treating relapsed/refractory multiple myeloma based on the MonumenTAL-1 trial data, potentially offering a new therapeutic option for this challenging patient population.

Panelists discuss how VRd (bortezomib, lenalidomide, dexamethasone) remains the standard frontline regimen for transplant-eligible newly diagnosed multiple myeloma (NDMM) patients, though some now consider adding daratumumab (dara-VRd) in high-risk cases.

Noopur Raje, MD, discusses the role of T-cell affinity in bispecific therapy for patients with relapsed/refractory multiple myeloma and how it impacts treatment practices.

The panel discusses the benefits of having multiple BCMA-targeting bispecifics available for patients with relapsed/refractory multiple myeloma.

Rafael Fonseca, MD, discusses the role of bispecifics in relapsed/refractory multiple myeloma and the implications of incorporating them into combination regimens.

Noopur Raje, MD, reviews clinical research on elranatamab combination therapy in patients with relapsed/refractory multiple myeloma.

Focusing on clinical trials evaluating combination strategies with bispecifics, Larysa J. Sanchez, MD, discusses the TRIMM-2, TRIMM-3, and MajesTEC-3 studies.

Rafael Fonseca, MD, discusses the MonumenTAL-2 and MonumenTAL-3 clinical trials investigating talquetamab combination strategies in relapsed/refractory multiple myeloma.

Hematologist-oncologists discuss GPRC5D-targeting treatments that are currently in development for patients with relapsed/refractory multiple myeloma.