ATLANTA — The recent approvals of axicabtagene ciloleucel and tisagenlecleucel T-suspension highlight the efficacy of CAR T-cell therapies for certain blood cancers. Updated data from the ZUMA-1 trial suggest that CAR T-cell therapies may also be effective for additional indications not yet approved by the FDA, according to Gwen Nichols, MD, chief medical officer of The Leukemia & Lymphoma Society.
Nichols spoke with HemOnc Today following a presentation by Sattva S. Neelapu, MD, professor in the department of lymphoma/myeloma at The University of Texas MD Anderson Cancer Center, at the ASH Annual Meeting and Exposition.
Neelapu and colleagues demonstrated that more than half of patients with refractory, aggressive non-Hodgkin lymphoma remained alive at least 1 year after receiving a single infusion of anti-CD19 chimeric antigen receptor T-cell therapy axicabtagene ciloleucel (Yescarta, Kite Pharma/Gilead Sciences).
“One area that I think is really of interest for patients with blood cancers is the role of immunotherapy, and one of the most exciting areas is the presentation of new CAR T data for patients with lymphoma,” Nichols told HemOnc Today.
“The [ZUMA-1] data shows some remarkable responses [among] patients who have failed other therapies,” she said. “It also shows that some other rarer subtypes of lymphoma, such as mantle cell lymphoma, may respond to CAR T-cell therapy.”
Additionally, study results demonstrated that after a median follow-up of 15.4 months, overall response rate was 82% and complete response rate was 58%. Forty-two percent of patients remained in remission and 40% had an ongoing complete response.
One of the concerns for patients with aggressive non-Hodgkin lymphoma who have failed effective standards of care has been that subsequent chemotherapies can be effective, but the duration of response generally diminishes with each subsequent therapy, Nichols said.
“These results imply that even heavily pretreated patients who have had a lot of prior chemotherapy can respond to an immunotherapeutic approach, and this means a completely different way of attacking the cancer,” she said. “So, it will be very interesting to find the patients who are able to respond by their immunologic parameters so that we can select the right patients and potentially move this exciting therapy to earlier in the course of treatment.”
Nichols acknowledged that The Leukemia & Lymphoma Society is supporting a significant amount of research in the use of immunotherapies, and how to better CAR T-cell treatment options.
“The folks who have done the ZUMA-1 trial are ... trying to pull out biomarkers of response so that [physicians] can really select the best patients,” she said. “Additionally, they are trying to pull out biomarkers of potential toxicity so that the drug is as safe as possible for patients. This is where a lot of dollars going into our research portfolio are being spent; to learn about different ways to manipulate CAR T therapy to make it safer, more effective and able to be used by more patients.”
Neelapu SS, et al. Abstract 578. Presented at: ASH Annual Meeting and Exposition; Dec. 9-12, 2017; Atlanta.
Disclosures: Nichols reports that the Leukemia & Lymphoma Society grants research funding to various clinical trials.