Chimeric antigen receptor T-cell therapy or CAR T is a breakthrough treatment for patients with certain types of blood cancers. The cellular therapy uses a patient's own immune cells that are reengineered to better seek out and destroy cancer cells. The single infusion treatment is approved for patients who have relapsed after two or more types of therapy but results from the ZUMA-7 clinical trial show lymphoma patients can benefit from receiving the CAR T product axicabtagene ciloleucel (Yescarta) sooner. The findings were published by the New England Journal of Medicine in conjunction with the 63rd annual American Society of Hematology annual meeting in Atlanta.
Led by Dr. Frederick Locke, vice chair of Moffitt Cancer Center's Blood and Marrow Transplant and Cellular Immunotherapy Department, ZUMA-7 is a nationwide, multicenter phase 3 trial evaluating Yescarta as a second-line therapy for patients with diffuse large B-cell lymphoma. In total, 359 patients were enrolled and randomized into two arms: Yescarta or standard of care. Patients in the Yescarta arm underwent apheresis to have CAR T cells produced for therapy. Those in the standard of care arm were given chemotherapy with the goal of getting them well enough for an autologous stem cell transplant.
We found that 94% of patients who were randomized to the CAR T arm actually received axicabtagene ciloleucel, a potentially definitive treatment for their lymphoma. Whereas alternatively, only about one-third of patients who were randomized to the standard of care eventually received a definitive stem cell transplant."
Dr. Frederick Locke, Vice Chair, Moffitt Cancer Center's Blood and Marrow Transplant and Cellular Immunotherapy Department
The two-year follow-up data shows that median event-free survival, meaning no cancer progression or need for additional treatment, was 8.3 months in the Yescarta arm compared to two months with standard of care. Also after 24 months, the estimates for ongoing remission with no need for additional therapy were 41% of those receiving Yescarta and 16% of those receiving standard of care.
Large B-cell lymphoma is the most common type of non-Hodgkin lymphoma. Roughly 40% of patients will relapse and require a second-line therapy. Locke says providing CAR T as an option sooner for this patient population can reduce exposure to toxic chemotherapy agents and provide better outcomes and a quicker recovery.
"The ZUMA-7 clinical trial results are truly remarkable and could lead to a paradigm shift in the way that we treat patients in the second-line setting for diffuse large B-cell lymphoma. Our goal is to give our patients the best possible treatment and quality of life," said Locke.
Funding for this trial was provided by Kite, a Gilead Company.
Locke, F.L., et al. (2021) Axicabtagene Ciloleucel as Second-Line Therapy for Large B-Cell Lymphoma. New England Journal of Medicine. doi.org/10.1056/NEJMoa2116133.