Ciltacabtagene Autoleucel Demonstrates Superior Efficacy Compared With Idecabtagene Vicleucel for Treatment of Triple-Class-Exposed R/R MM

Compared with idecabtagene vicleucel (ide‐cel) treatment, ciltacabtagene autoleucel (cilta‐cel)treatment for relapsed/refractory (RR) multiple myeloma (MM) was associated with increased durability and improved cancer outcomes, according to results from a multicenter retrospective observational study published in HemaSphere.

Previous research has demonstrated the efficacy of both idecabtagene vicleucel and ciltacabtagene autoleucel for the treatment of R/R MM. However, there is limited comparison between the CAR-T therapies. Researchers conducted the first real-world comparison on the safety and efficacy of idecabtagene vicleucel and ciltacabtagene autoleucel among patients with R/R MM.

Comparison of progression free survival (PFS) for both idecabtagene vicleucel and ciltacabtagene autoleucel was the primary end point. Secondary end points were overall response rates (ORR), overall survival (OS), and non-relapse mortality, and safety for both lines of therapy.

Patients (n = 204) with R/R MM, who had a history of less than 3 prior lines of therapy, were included and infused with either idecabtagene vicleucel (n=162) or ciltacabtagene autoleucel (n = 42). Patients had a median age of 61 years. Time between diagnosis and therapy infusion was longer in the idecabtagene vicleucel group than the ciltacabtagene autoleucel group (7.4 years vs 6.9 years, P = .53). Additionally, time from apheresis and infusion was shorter in the idecabtagene vicleucel group than the ciltacabtagene autoleucel group (47 days; range, 28 to 190 vs 68 days; range, 22 to 139).

The 10-month PFS was higher in the ciltacabtagene autoleucel group (82%; 95% confidence interval [CI], 70 to 94; P< .001) than the idecabtagene vicleucel group (47%; 95% CI, 39 to 55). The ORR was higher among the ciltacabtagene autoleucel group (93%) than the idecabtagene vicleucel group (79%). Similarly, OS was higher for patients infused with ciltacabtagene autoleucel (90%; 95% CI, 81 to 99) than idecabtagene vicleucel (77%; 95% CI, 70 to 84; P= .06). Also at 10 months, NRM was lower in the idecabtagene vicleucel group (3%; 95% CI, 0 to 5) than the ciltacabtagene autoleucel group (5%; 95% CI, 1 to 4). 

Cytokine release syndrome (CRS) incidence was slightly higher in the idecabtagene vicleucel group than the ciltacabtagene autoleucel group (81% vs 85%; P= .51). CRS incidence at grade 3 or higher occurred more often in the ciltacabtagene autoleucel group (10%) than the idecabtagene vicleucel group (4%).  Immune-effector cell-associated neurotoxicity syndrome (ICANS) incidence was the same for both groups (19%), however incidence of ICANS grade 3 or higher was higher among patients infused with ciltacabtagene autoleucel (7%) than idecabtagene vicleucel (2%). However, delayed neurotoxicity occurred in more patients treated with idecabtagene vicleucel than ciltacabtagene autoleucel (4 vs 2).

Among all patients, 47 deaths occurred, of which 43 were in the idecabtagene vicleucel group. Relapse or progression was the main cause of death in 74% of patients treated with idecabtagene vicleucel and 25% of patients treated with ciltacabtagene autoleucel.

“Our study provides real-world evidence that ciltacabtagene autoleucel treatment leads to superior outcomes compared to idecabtagene vicleucel in triple-class exposed RRMM patients,” the researchers concluded, adding, “despite comparable and low non-relapse mortality in both treatment groups, the different toxicity profiles of ciltacabtagene autoleucel must be taken into account in routine clinical practice.”

Source:

Merz M, Anca‐Maria Albici, Bastian von Tresckow, et al. Idecabtagene vicleucel or ciltacabtagene autoleucel for relapsed or refractory multiple myeloma: An international multicenter study. HemaSphere. Published online January 16, 2025. doi: 10.1002/hem3.70070