Jason Romancik, MD, assistant professor, Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, discusses efforts to maximize the efficacy of CAR T-cell therapy in non-Hodgkin lymphoma (NHL).

Advancements in CAR T-cell therapy have allowed patients with NHL to potentially experience long-term remission, Romancik says. However, a minority of patients achieve this outcome, creating an unmet need to improve the efficacy of this therapeutic option, Romancik says.

Several studies investigated the use of CAR T-cell therapies in earlier treatment lines and showed increased efficacy vs current standard-of-care options, Romancik notes. Moreover, there is interest in utilizing this therapy for the first-line treatment of high-risk patient populations, Romancik adds.

CAR T-cell therapy can lead to delayed treatment administration, which decreases patient outcomes, Romancik continues. However, the use of allogeneic CAR T-cell products could help minimize these factors, Romancik concludes.

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Jason Romancik, MD, discusses efforts to maximize the efficacy of CAR T-cell therapy in non-Hodgkin lymphoma.

Dr. Romancik on Maximizing CAR T-cell Therapy in NHL 

Jason Romancik, MD, assistant professor, Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, discusses the benefit of axicabtagene ciloleucel (axi-cel; Yescarta) vs standard of care as a second-line treatment for patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL).

The phase 3 ZUMA-7 trial (NCT03391466) evaluated axi-cel vs standard-of-care treatment as second-line therapy for patients with relapsed/refractory DLBCL. The study had a primary end point of event free survival (EFS), Romancik continues. In April 2022, 

the FDA approved axi-cel for the treatment of adult patients with large B-cell lymphoma

 that is refractory to first-line chemoimmunotherapy or relapses within 12 months of first-line chemoimmunotherapy based on findings from ZUMA-7.

The trial compared standard-of-care salvage chemotherapy followed by autologous stem cell transplant in responders vs axi-cel, Romancik continues. The CAR T-cell therapy significantly improved EFS, though an overall survival benefit was not observed, Romancik concludes.

Jason Romancik, MD, discusses the benefit of axicabtagene ciloleucel vs standard of care as a second-line treatment for patients with relapsed/refractory diffuse large B-cell lymphoma.


Dr. Romancik on the Benefit of Second-line Axi-cel in R/R DLBCL

Jason Romancik, MD, assistant professor, Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, discusses the design and key results from the phase 2 PILOT study (NCT03483103).

The single-arm study evaluated the efficacy and safety of lisocabtagene maraleucel (liso-cel, Breyanzi) in the second-line setting for transplant-ineligible patients with relapsed/refractory aggressive B-cell non-Hodgkin lymphoma (NHL). The study had no comparison to current standard of care, Romancik states.

Patients included in the study population were predominantly high-risk and had generally poor prognosis, Romancik continues. The median age of participants was 74 years, and a majority of patients had medical comorbidities that made them ineligible for hematopoietic stem cell transplantation (HSCT). Patients with poor performance status were also eligible for enrollment, and 26% of patients had an ECOG performance status of 2. Furthermore, most patients relapsed within 1 year of first-line therapy. Researchers also utilized the HCT comorbidity index (HCT-CI) to evaluate and predict treatment-related mortality, and 44% of patients had an HCT-CI score greater than 3.

Results from the PILOT study showed an overall survival response of 80% and a complete response rate of 54%. Although median progression-free survival was capped at 9 months, the tail end of the Kaplan-Meier survival curve started to plateau at this cut-off, indicating that some patients may experience long-term benefit or long-term remission from this treatment, Romancik concludes.

Jason Romancik, MD, discusses the design and key results from the phase 2 PILOT study.

Jason Romancik, MD

Articles

Dr. Romancik on Maximizing CAR T-cell Therapy in NHL

Dr. Romancik on the Benefit of Second-line Axi-cel in R/R DLBCL

Dr. Romancik on the Phase 2 PILOT Study of Liso-Cel in Aggressive B-Cell NHL