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Published on December 11, 2020
Researchers Present Benefits of CAR T-Cell Therapy for Relapsed NHL Patients at ASH 2020
Patients with relapsed or refractory indolent non-Hodgkin lymphoma (iNHL) can greatly benefit from CAR (chimeric antigen receptor) T-cell therapy, researchers say. So far, iNHL has been largely incurable with conventional therapies. It is slow-growing in nature but has a high likelihood of relapse. For patients who have been through at least two lines of therapy, this new option looks promising.
T cells fight infection. CAR T-cells are blood cells that are taken out of a patient, altered and put back into the patient. Think of it like an oil change where instead of being replaced, the oil is removed, modified and put back into the vehicle to improve its functionality. CAR T-cell therapy works similarly.
The Phase II ZUMA-5 Clinical Trial
The novel therapy axicabtagene ciloleucel (Yescarta), or axi-cel, resulted in high response rates, according to results of the phase II ZUMA-5 study announced at the American Society of Hematology (ASH) Annual Meeting.1
The study included 146 patients with iNHL: 124 had follicular lymphoma (FL) and 22 had marginal zone lymphoma (MZL). The median age was 61 years (range, 34 to 79 years) with 57% of the patients male. The process of extracting the blood cells, altering them and infusing them back into patients took approximately 17 days. The trial is continuing to accrue patients in the MZL arm.
Patients were checked on after 12 months and the results are promising! The FL group had an 80 percent complete response rate and the MZL group had a 60 percent complete response rate. It’s not a cure, but it can mean complete remission because the cancer cells were no longer detectable.
“We were very impressed with the magnitude of the responses, and also the durability,” said Caron Jacobson, MD, MMSc, who led the trial and presented the findings at ASH 2020. “This treatment has meaningfully impacted high-risk patients with these diseases. I was also struck early on by how favorable the safety profile was compared to what we’ve been seeing in the fast-growing lymphomas,” she said in a news release from Dana-Farber Cancer Institute.
The most common adverse effects were neutropenia (33 percent), decreased neutrophil count (27 percent) and anemia (23 percent). Some patients experienced a more serious problem called cytokine release syndrome (CRS), when the immune system goes into hyperdrive. Symptoms of CRS include fever, nausea, headache, rash, rapid heartbeat, low blood pressure and trouble breathing. Most patients have a mild reaction, but sometimes, the reaction may be severe or life-threatening, according to the National Cancer Institute.2
A Positive Look to the Future
During her presentation at ASH 2020, Dr. Jacobson concluded that “Axi-cel yields high rates of response in indolent non-Hodgkin lymphoma with an overall response rate of 92 percent and a CR [complete response] rate of 76 percent. Although longer follow-up is needed, these responses appear to be durable,” she said.
“I would like to thank the patients, and their families, friends and caregivers first and foremost without whose participation and generosity, this study could not have been done,” Dr. Jacobson added.
1Jacobson C, Chavez JC, Sehgal AR, et al. Primary analysis of Zuma-5: a phase 2 study of axicabtagene ciloleucel (axi-cel) in patients with relapsed/refractory (r/r) indolent non-Hodgkin lymphoma (iNHL). Presented at: 62nd American Society of Hematology (ASH) Annual Meeting and Exposition; December 5-9, 2020. Abstract 700.
2Cytokine Release Syndrome. National Cancer Institute.
3CAR T-cell therapy found highly effective in patients with high-risk non-Hodgkin lymphoma. Dana Farber Cancer Institute.
4Mantle Cell and Indolent B-Cell Lymphoma – CAR-T and immunotherapy clinical studies. (Presentation 623). American Society of Hematology (ASH) Annual Meeting and Exposition.
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