Ankit Kansagra, MD, assistant professor in the Department of Internal Medicine at Harold C. Simmons Comprehensive Cancer Center of UT Southwestern Medical Center, discusses key updates with CAR T-cell therapy in hematologic cancers.

Many fantastic updates have been presented in CAR T-cell therapy in this space, with real-world evidence, says Kansagra. One of these updates has been seen with axicabtagene ciloleucel (axi-cel; Yescarta), which has been out for about 2 years now. More than 500 patients countrywide in more than 50 institutions were treated with this product and were monitored by the Center for International Blood and Marrow Transplant Research. Investigators noticed that this therapy was very efficacious, which is the most important information from the update, adds Kansagra. Sometimes, a drugmight appear to be efficacious in clinical trials but that activity is not replicated in the real world. The toxicity or safety profile of the agent in the real-world setting was also very comparable to what had been reported in clinical trials.

Another thing learned in the clinical setting is that medications to prevent or treat cytokine release syndrome (CRS) or other toxicitieswere more frequently used in the real-world setting than what had been seen in clinical trials. Medications, such as steroids and/or tocilizumab (Actemra), which is a common medication used to treat CRS, were used much more in the real-world setting than in clinical trials, concludes Kansagra.

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Ankit Kansagra, MD, discusses key updates with CAR T-cell therapy in hematologic cancers.

Dr. Kansagra on Updates With CAR T-Cell Therapy in Hematologic Cancers

Ankit Kansagra, MD, assistant professor in the Department of Internal Medicine at Harold C. Simmons Comprehensive Cancer Center of UT Southwestern Medical Center, discusses updates with CAR T-cell therapy in multiple myeloma.

The phase Ib/II CARTITUDE-1 trial sought to characterize the safety of JNJ-4528 and establish the recommended dosage. Results showed that the BCMA-directed CAR T-cell therapy achieved a 100% overall response rate (ORR) with early and deep responses in 29 patients with heavily pretreated relapsed/refractory myeloma at a median follow-up of 6 months. The ORR consisted of a 66% stringent complete response (CR) rate, a 3% CR rate, a 17% very good partial response (PR) rate, and a 14% PR rate.

Data have also been reported with the CAR T-cell therapy idecabtagene vicleucel (ide-cel; bb2121), which is, to some extent, a similar product. However, ide-cel has the potential to be given in an outpatient setting, depending on the cytokine release or the toxicity that occurred.

Moreover, even with a lower dose, good efficacy is being reported with this therapy, says Kansangra. It is difficult to compare 2 different products, but investigators are seeing how this construct was made and they might be able to achieve very good efficacy as it is examined further in trials, concludes Kansagra.

Ankit Kansagra, MD, discusses updates with CAR T-cell therapy in multiple myeloma.

Dr. Kansagra on Updates With CAR T-cell Therapy in Myeloma

Ankit Kansagra, MD, assistant professor, Department of Internal Medicine, Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, discusses remaining questions with CAR T-cell therapy in multiple myeloma.

CAR T-cell therapy has shown unprecedented activity in multiple myeloma, explains Kansagra.

Combining CAR T-cell therapy with other drugs may improve T-cell persistence; however, investigational combinations are still in preclinical stages of research, says Kansagra. CAR T-cell therapy could also show enhanced responses earlier on in treatment. As such, several trials are evaluating CAR T-cell therapy in the early relapse setting rather than in heavily pretreated patient populations.

Furthermore, little is known about the optimal treatment for patients who progress on CAR T-cell therapy. This is an area of unmet need that requires further investigation, concludes Kansagra.

Ankit Kansagra, MD, discusses remaining questions with CAR T-cell therapy in multiple myeloma.

Dr. Kansagra on Remaining Questions With CAR T-Cell Therapy in Multiple Myeloma

Ankit Kansagra, MD, assistant professor, Department of Internal Medicine, Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, discusses the expanding role of CAR T-cell therapy in lymphoma and multiple myeloma.

The utility of CAR T-cell therapy is rapidly growing in oncology, explains Kansagra. In October 2017, the FDA approved axicabtagene ciloleucel (axi-cel; Yescarta) for the treatment of adult patients with relapsed/refractory large B-cell lymphoma following ≥2 lines of systemic therapy. Additionally, in May 2018, the FDA approved tisagenlecleucel (Kymriah) for use in the same indication.

Ongoing clinical trials are investigating the efficacy of moving CAR T-cell therapy into earlier lines of treatment in B-cell lymphomas, says Kansagra.

Data from the 2019 ASH Annual Meeting continue to show unprecedented efficacy with CAR T cells in the treatment of patients with relapsed/refractory multiple myeloma.

Collaborating with CAR T-cell therapy experts, as well as increasing the number of institutions that are certified to treat with immune-based therapies may increase patient access to these treatment modalities, concludes Kansagra.

Ankit Kansagra, MD, discusses the expanding role of CAR T-cell therapy in lymphoma and multiple myeloma.

Ankit Kansagra, MD

Articles

Dr. Kansagra on Updates With CAR T-Cell Therapy in Hematologic Cancers

Dr. Kansagra on Updates With CAR T-cell Therapy in Myeloma

Dr. Kansagra on Remaining Questions With CAR T-Cell Therapy in Multiple Myeloma

Dr. Kansagra on Expanding Role of CAR T-Cell Therapy in Lymphoma and Multiple Myeloma