Babis Andreadis, MD
Chimeric antigen receptor (CAR) T-cell therapy exploded onto the scene in 2017 with the approval of tisagenlecleucel (Kymriah) in acute lymphoblastic leukemia (ALL) and axicabtagene ciloleucel (axi-cel; Yescarta) in non-Hodgkin lymphoma (NHL).
State of the Science SummitTM on Hematologic Malignancies, Babis Andreadis, MD, associate professor of clinical medicine, Department of Medicine, director, Clinical Research Support Office, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, reflected on the successes seen with CAR T-cell development in the past year and the use of CAR T-cell therapy in patients with NHL.
OncLive: Please provide an overview of your presentation on CAR T-cell therapy in NHL.
: We are living in an exciting era in lymphoma therapy because of the recent developments in immunotherapy, specially CAR T-cell therapies. In 2017, we saw the approval of 2 novel therapies in patients with ALL and diffuse large B-cell lymphoma. My talk focused on how these therapies work and what are the expected management complications and toxicities associated with them. In the lymphoma sphere, we know that both therapies can produce 30% to 40% long-term responders, meaning people who are out 6 months or more with a complete response. The goal is to determine whether those patients can be seen as longer-term responders and eventually be cured. We think CAR T-cell therapy has the ability to do that.
This great era that we have been waiting for is here, and we now have a therapy that works for patients who don't have any other options.
How have you noticed the approvals of axicabtagene and tisagenlecleucel impacting the treatment landscape?
We have seen a big uptake in referrals. People with large cell lymphoma have a great chance at cure. Frontline treatment cures 60% to 70% of patients, and if they relapse, second-line treatment cures about 25% of patients. Historically, patients who don't respond to the second-line treatment have no options, and their 1-year survival rates are somewhere around 10%.
Therefore, these patients would not have been referred to major centers, historically; they would have been managed locally and in a palliative manner. However, now we are seeing all of these patients being referred because they believe there is finally an option that can work. Everyone has a good chance.
Will we ever reach a point where this therapy could be implemented widely across the country?
There are some parts to it that we are being careful about. The structure of the treatment is much like a stem cell transplant in that you need a stem cell collection, the manufacturer, the intravenous administration, and toxicity monitoring. Therefore, the structure of the treatment requires a lot of resources that the average community practice does not employ.
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