Where Is Research Today on BiTEs and CAR-T Cell Therapy? | Transcript | Multiple Myeloma | Patient Power


Where Is Research Today on BiTEs and CAR-T Cell Therapy?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Mo, what’s a BiTE? What is this? 

Dr. Trikha:                  

So, what the BiTE is it’s an ability to take two antibodies. So, think of a monoclonal antibody. So, we had first generation. We had a monoclonal antibody that would bind to a certain antigen or a target on a cancer cell. And that was called monoclonal. Through genetic engineering and molecular biology, what we’ve been able to do now is one side binds to the cancer cell, the myeloma cell. The other side binds to a T-cell receptor. So, that’s a CD3 receptor, for example. And then by bringing those two together in the right position, what you’re able to do now is that those T cells can now attack and kill those myeloma cells. 

So, that’s what this version of a BiTE that’s coming out that is showing really profound—so, we just talked a little bit earlier about CAR Ts, which was basically you take the cells. You engineer them. You put them back into your body. And those cells will then attack. This is a different way of activating those T cells that will kill your cancer cell—the myeloma cell in this case.  

Andrew Schorr:          

Now, if I understand correctly, the BiTES though might be kind of an ongoing treatment, right? Whereas CAR T is maybe a once only? 

Dr. Trikha:                  

Yes. So, the idea with a BiTE is—so, you sometimes—with the first generation that we tested that we brought forward is what requires continuous infusion. Because they have—they disappear from your body. They have what’s called a faster half-life or faster clearance, a shorter half-life. 

Now, scientists are starting to make what we call second-generation BiTES or second-generation BiTE specifics, which perhaps you can inject once a week, maybe even once every three weeks. Whereas with the CAR Ts, originally we were talking about – and there’s some data coming out like Morgan talked about. These are single infusions. And you give them once and then you see a response. 

Esther Schorr:             

Can I ask—I have a question then. 

Andrew Schorr:          

Yeah, sure. 

Esther Schorr:             

There’s a lot of working with T cells here. And is there some retraining that’s going on? Like once one of these treatments is done do your T-cells potentially learn something that they… 

Andrew Schorr:          

…do they remember? 

Esther Schorr:             

Do they remember stuff?

Dr. Morgan:                

It’s back to the days of blindfolding your T cells. Your immune system can’t see the cancer. And they use like the Klingon cloaking device. The tumors are blind to the immune system. And what you’re saying is completely correct. 

You’re retraining the immune system to see the cancer cells. And so, you can see it has a different mechanism. It’s l that probably combines with chemotherapy, anti-apoptosis drugs. So, we have the chance to build curative regimens and push patient survival out in the upfront setting.  

Esther Schorr:             

Okay. That helps. 

Dr. Trikha:                  

What happens is there really is a memory. So, to your point, are we training? These T cells are fascinating. Once they—you can reactivate that memory. And you can get these T-cell memory cells to further get activated. And that’s kind of where we’re thinking about the next frontier is to say you activate the T cell. It fights the cancer. If the cancer subsides, if it relapses, could you reactivate those T cells again? 

Esther Schorr:             

So, could there then be a stop in treatment at some point if you use one of these therapies? 

Mohit Trikha:              

Ideally, the CAR T’s a one and done. 

Esther Schorr:             

So, you’ve done the training and they go off and they do their thing.  

Dr. Trikha:                  

They come in. They do their job. And they either exist there long term where they’re still effective.

Jack Aiello:                 

Right. Proliferate. But we don’t know how long it lasts. 

Esther Schorr:             

Right. 

Dr. Morgan:                

We don’t.  

Dr. Trikha:                  

We don’t know how long it lasts. It’s still early days, right? We’ve got to be mindful. Sample sizes of patients. 

Esther Schorr:             

Don’t get too excited. Not yet. 

Dr. Trikha:                  

So, please – things change. And I can tell you first hand—all of us can tell you it takes a while. We need to learn how to fight cancer. 

Dr. Morgan:                

See, just to illustrate. So, like daratumumab, Darzalex—okay? It’s a great drug. It’s been a great step forward. In the relapse refractory setting, it was 20 percent response rate, improvement in survival, 3 months. These things are getting 80 percent response rates and 11 to 22 months progression-free survival. So, they’re going to be more effective than the single monoclonal antibody.  

Andrew Schorr:          

Yeah. But it’s right now, a very expensive approach. 

Dr. Morgan:                

There are a lot of things to sort out. And do you do CAR T, or do you go with a bi-specific? That’s the real question.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on January 8, 2019