Dr. Andreadis on Developments to CAR T-Cell Therapy

Charalambos (Babis) Andreadis, MD, MSCE, associate professor of clinical medicine, Department of Medicine, UCSF Helen Diller Family Comprehensive Cancer Center, discusses developments being made to chimeric antigen receptor (CAR) T-cell therapy for patients with hematologic malignancies.

In 2017, the FDA approved tisagenlecleucel (Kymriah) in acute lymphoblastic leukemia (ALL) and axicabtagene ciloleucel (axi-cel; Yescarta) in non-Hodgkin lymphoma (NHL). Tisagenlecleucel was the first FDA-approved CAR T-cell therapy, and is indicated for the treatment of patients up to 25 years of age with B-cell precursor ALL that is refractory or in second or later relapse.

According to Andreadis, physicians are beginning to understand who should not receive CAR T-cell therapy. It does not appear that patients who relapse lose CD19, which is the main antigen that is employed in CAR T-cell therapy.

Lack of persistence is not a marker of relapse, says Andreadis. The reason that patients are failing is that the T cells get exhausted. Investigators are working on ways to increase T-cell function as the next wave of improvements in this therapy.