Brian Till, MD
The recent advances with chimeric antigen receptor (CAR) T-cell therapy in select hematologic malignancies have been exciting; however, more research is needed to move these treatments into an earlier treatment setting and drive down their costs, according to Brian Till, MD.
There are currently 2 FDA-approved CAR T-cell therapies: tisagenlecleucel (Kymriah) and axicabtagene ciloleucel (axi-cel; Yescarta). A third, lisocabtagene maraleucel (liso-cel; JCAR017), has shown promise in a phase I clinical trial.
In data from the multicenter TRANSCEND study, liso-cel demonstrated a durable complete remission rate of 46% at 6 months for patients with high-risk diffuse large B-cell lymphoma (DLBCL).
The multicenter TRANSCEND-NHL-006 study is determining the efficacy and safety of liso-cel in adult subjects who have relapsed from or are refractory to a single line of chemoimmunotherapy for aggressive B-cell non-Hodgkin lymphoma and are ineligible for hematopoietic stem cell transplant (NCT03483103).
The primary endpoint of the study is overall response rate, with a secondary analysis on patient-reported health-related quality of life. Till says these data are not yet available.
In an interview at the 2018 OncLive®
State of the Science Summit™ on Hematologic Malignancies, Till, an associate member of the Clinical Research Division at Fred Hutchinson Cancer Research Center, and professor of medicine at the University of Washington, discussed the rapidly evolving field of CAR T cells.
OncLive: You spoke about the current state of CAR T-cell therapy. What is important to highlight from your presentation?
: In my presentation, I spoke about the role of CAR T cells, particularly in treating pediatric and young adults with ALL and in adults with DLBCL. I gave some background on how the CAR works. There have been some pretty exciting, recent multicenter data with CAR T cells.
The key message with using CAR T cells is that these are very high-risk patients who have relapsed disease and poor outcomes. CAR T-cell therapy has shown promising results. Some relapses do occur; but in general, if patients make it past 6 months or so, they will have durable responses. We need more follow-up to really understand this.
What impact have tisagenlecleucel and axi-cel had on the landscape?
It's still pretty early days. These agents have only been FDA approved for a short period of time, so there is a learning curve still attached to them. These agents are not widely available at every cancer center, but we're fortunate right now to have access to them [at Fred Hutchinson Cancer Research Center]. When we get into a situation where a patient has relapsed on standard treatment, we would refer in this direction [of CAR T-cell therapy]. Some of the common scenarios in which we're using this treatment are in DLBCL. These patients get their salvage therapy, and if they don't get a complete response we would put them on CAR T cells.
Beyond the 2 that are available, what other CAR T-cell therapies are in development?
Following on the heels of the 2 FDA-approved therapies, we have liso-cel. This hasn't been FDA approved yet, but it's in the middle of a clinical trial where we have seen promising data. It hasn't been fully reported yet, but the preliminary results look great. I can see an approval forthcoming at some point. There are other CAR T cells in development, as well. We have a CD20-targeted CAR that we're looking at. Other centers are looking at CD22-targeted CARs for patients with acute lymphoblastic leukemia.