First Dual CAR T Cell Treatment on the Horizon for Multiple Myeloma
Many companies now have CAR T cell therapies in development for multiple myeloma. The most popular target in multiple myeloma seems to be BMCA (the B-cell maturation protein). Novartis, Juno Therapeutics, Celgene/Bluebird and Legend Biotech all hope to bring BCMA CAR T products to market. Additional CAR T Cell protein targets are also in development. For example, the UPENN research started with the CD19 target which is highly effective in leukemia and lymphoma, but is not typically found on the surface of myeloma cells. When UPENN ran a study using CD19 for multiple myeloma patients, one patient had a remarkable response that lasted a year but other patients had lower level responses. Researchers believed the CD19 target could potentially be effective in reaching early stem cells before they became myeloma cells. A company called Syncona has now begun three clinical trials to use a dual target for relapsed/refractory patients. It has now completed the first dose cohort of a Phase I/II study and is the first study to test a dual CAR T cell therapy in multiple myeloma. Their selection of the targets is due, in part, to the potential loss of BCMA once the cancerous cells become smart enough. Sometimes they can "lose" the BCMA signature when they realize they are being attacked.
By targeting certain areas of the same cancer cell, more patients may be eligible for CAR-T treatment and less patients may be at risk of cancer relapse due to loss of B-cell maturation antigen expression on their cancer.
The CAR T Cell targets are targeting CD10 and CD22 with independently-acting CARs. Similarly, the research funded by the Myeloma Crowd Research initiative is targeting a dual CAR T target as well - CS1 and BCMA. To learn more or donate to this project, click here. As the CAR T Cell products enter clinical trials, investigators will learn how to better combine the therapies in hopes of a cure.