1
|
Hillis C, Vicente C, Ball G. The Cost Effectiveness of Axicabtagene Ciloleucel Versus Best Supportive Care in the Treatment of Adult Patients with Relapsed or Refractory Large B-Cell Lymphoma (LBCL) After Two or More Lines of Systemic Therapy in Canada. PHARMACOECONOMICS 2022; 40:917-928. [PMID: 35844002 DOI: 10.1007/s40273-022-01169-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Axicabtagene ciloleucel (axi-cel) received marketing authorisation in Canada for the treatment of relapsed or refractory large B-cell lymphoma after two or more lines of systemic therapy, and the clinical and economic value of axi-cel to patients and the healthcare system should be examined. The objective of this analysis is to determine, from societal and public healthcare payer perspectives, the cost effectiveness of axi-cel versus best supportive care for patients with relapsed or refractory large B-cell lymphoma in Canada. METHODS A pharmacoeconomic model was developed and populated with clinical data derived from the ZUMA-1 and SCHOLAR-1 studies using a propensity score-matched comparison. A partitioned survival mixture-cure modelling approach was taken to characterise the potential curative effect of axi-cel therapy in large B-cell lymphoma. Healthcare resource utilisation and adverse event data were based on results from ZUMA-1, and utility values were derived from ZUMA-1 data supplemented with published literature. Costs (in 2021 Canadian dollars) were taken from publicly available Canadian cost databases and published literature. Benefits and costs were discounted at 1.5% per year, and sensitivity analyses were conducted to assess the robustness of the results. RESULTS In the base case, axi-cel generated an incremental 6.2 life-years compared to best supportive care, corresponding to 4.6 additional quality-adjusted life-years, and was associated with $606,010 in additional costs. The incremental cost-utility ratio was $132,747 per quality-adjusted life-year gained compared with best supportive care from a societal perspective ($106,392 per quality-adjusted life-year gained from a public healthcare payer perspective). Key drivers of the analysis included progression-free survival and overall survival values for axi-cel. CONCLUSIONS The results of this analysis suggest that axi-cel may be considered a cost-effective allocation of resources compared with best supportive care for the treatment of adult patients with relapsed or refractory large B-cell lymphoma in Canada.
Collapse
Affiliation(s)
| | | | - Graeme Ball
- Gilead Sciences Canada Inc., Mississauga, ON, Canada
| |
Collapse
|
2
|
Wang XJ, Wang YH, Ong MJC, Gkitzia C, Soh SY, Hwang WYK. Cost-Effectiveness and Budget Impact Analyses of Tisagenlecleucel in Pediatric and Young Adult Patients with Relapsed or Refractory B-Cell Acute Lymphoblastic Leukemia from the Singapore Healthcare System Perspective. CLINICOECONOMICS AND OUTCOMES RESEARCH 2022; 14:333-355. [PMID: 35535300 PMCID: PMC9078873 DOI: 10.2147/ceor.s355557] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/07/2022] [Indexed: 12/29/2022] Open
Abstract
Purpose Children and young adults with relapsed or refractory (r/r) acute lymphoblastic leukemia (ALL) have poor survival due to ineffective therapy options. The newly approved chimeric antigen receptor T-cell (CAR-T) therapy, tisagenlecleucel, has demonstrated improved survival but at a high up-front cost. The study aims to evaluate the cost-effectiveness and budget impact of tisagenlecleucel versus salvage chemotherapy regimen (SCR) or blinatumomab (BLN) for the treatment of pediatric and young adult patients with relapsed/refractory B-cell ALL from the Singapore healthcare system perspective. Patients and Methods A three-health state partitioned survival model was constructed to analyze the cost-effectiveness of tisagenlecleucel vs SCR/BLN with/without allogenic hematopoietic stem cell transplantation (allo-HSCT) over a lifetime period. Clinical efficacy for tisagenlecleucel, SCR and BLN were based on pooled data from ELIANA, ENSIGN and B2101J trials, the study by von Stackelberg et al 2011, and MT103-205 respectively. Medical costs from pre-treatment until terminal care, including treatment, side effects, follow-up, subsequent allo-HSCT and relapse, were considered. Incremental cost-effectiveness ratios (ICERs) were estimated as the incremental costs per quality-adjusted life-year (QALY) gain. Additionally, the financial impact of tisagenlecleucel introduction in Singapore was estimated, comparing the present treatment scenario (without tisagenlecleucel) with a future scenario (with tisagenlecleucel), over 5 years. Results In the base-case analysis, tisagenlecleucel treatment demonstrated cost-effectiveness with an ICER of S$45,840 (US$34,762) per QALY (vs SCR) and S$51,978 (US$39,315) per QALY (vs BLN). The estimated budget ranges from S$477,857 (US$361,438) to S$1.4 million (US$1.05 million) annually for the initial 5 years. Conclusion Tisagenlecleucel is likely to be a cost-effective treatment option with limited budget implications while treating r/r ALL patients who have failed at least 2 lines of prior therapies.
Collapse
Affiliation(s)
- Xiao Jun Wang
- Novartis Singapore Pte Ltd, Singapore
- Correspondence: Xiao Jun Wang, Novartis Singapore Pte Ltd, 20 Pasir Panjang Road, #10-25/28 Mapletree Business City (West Tower), 117439, Singapore, Tel +65 67226010, Email
| | - Yi-Ho Wang
- Novartis Asia Pacific Pharmaceuticals Pte Ltd, Singapore
| | | | | | | | - William Ying Khee Hwang
- National Cancer Centre Singapore, Singapore
- Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| |
Collapse
|
3
|
Real World Evidence of CAR T-Cell Therapies for the Treatment of Relapsed/Refractory B-Cell Non-Hodgkin Lymphoma: A Monocentric Experience. Cancers (Basel) 2021; 13:cancers13194789. [PMID: 34638273 PMCID: PMC8507677 DOI: 10.3390/cancers13194789] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary CAR T-cell therapies have undoubtedly revolutionized the treatment of relapsed/refractory B-cell non-Hodgkin lymphoma. These therapies represent a valuable new treatment option, yielding impressive complete remission rates and improving survival. The aim of this article is to give an overview of emerging real-world evidence since data from every-day clinical practice are still scarce. We report effectiveness and safety data on 30 patients treated at our Institution. Treatment in this setting with CD19-targeted CAR T-cell therapies for relapsed/refractory B-cell non-Hodgkin lymphoma showed a manageable safety profile and high objective response rate, confirming the encouraging results of the pivotal clinical trials. Abstract Large B-cell lymphomas (LBCL) are the most common types of non-Hodgkin lymphoma. Although outcomes have improved thanks to the introduction of rituximab-based chemoimmunotherapy, certain LBCL still represents a challenge because of initial resistance to therapy or recurrent relapses. Axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel) are second-generation autologous CD19-targeted chimeric antigen receptor (CAR) T-cell therapies approved for patients with relapsed/refractory (R/R) LBCL, based on the results of phase II pivotal single-arm trials ZUMA-1 (for axi-cel) and JULIET (for tisa-cel). Here, we report patients outcomes with axi-cel and tisa-cel in the standard of care (SoC) setting for R/R LBCL, treated at our Institution. Data were collected from patients who underwent leukapheresis between August 2019 and February 2021. Toxicities were graded and managed according to the institution’s guidelines. Responses were assessed as per Lugano 2014 classification. Of the 30 patients who underwent leukapheresis, 18 (60%) received axi-cel, while 12 (40%) tisa-cel. Grade 3 or higher cytokine release syndrome and neurotoxicity occurred in 10% and 16% patients, respectively. Best objective and complete response rates were 73.3% and 40%, respectively. Treatment in SoC setting with CD19 CAR T-cell therapies for R/R LBCL showed a manageable safety profile and high objective response rate.
Collapse
|
4
|
Serra López-Matencio JM, Gómez Garcia de Soria V, Gómez M, Alañón-Plaza E, Muñoz-Calleja C, Castañeda S. Monitoring and safety of CAR-T therapy in clinical practice. Expert Opin Drug Saf 2021; 21:363-371. [PMID: 34519234 DOI: 10.1080/14740338.2021.1979958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION In the last few years, a new T cell therapy, chimeric antigen receptor-T (CAR-T) cells, has been developed. CAR-T cells are highly effective at inhibiting antitumor activity, but they can cause a wide spectrum of unusual side effects. AREAS COVERED The present review provides an overview of the adverse events of CAR-T cell therapy, focusing on cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, increased risk of infections, and other long-term complications. Representative studies addressing the safety and efficacy of CAR-T cell therapy are summarized. EXPERT OPINION In the coming years, we predict a great expansion in the use of CAR-T cell therapy with it applied to a higher number of patients with both malignant neoplasms and immune-mediated diseases. Despite physicians and patient expectations about the potential of this therapy, there are still several barriers that may limit providers' ability to supply quality care. This exciting and powerful new therapy requires the formation of new multidisciplinary teams to carry out a safe treatment administration and to successfully manage the resultant complications. The follow-up of these therapies is important for two aspects: effectiveness in different populations and real-life safety in short and in long-term follow-up.
Collapse
Affiliation(s)
| | | | - Manuel Gómez
- Methodology Unit, Health Research Institute Princesa (IIS-IP), Madrid, Spain
| | - Estefanía Alañón-Plaza
- Hospital Pharmacy Department, Hospital Universitario de La Princesa, IIS-P, Madrid, Spain
| | | | - Santos Castañeda
- Rheumatology Division, Hospital Universitario de La Princesa, IIS-IP, Madrid, Spain.,Catedra UAM-Roche, EPID-Future, Medicine Department, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| |
Collapse
|
5
|
Myers GD, Verneris MR, Goy A, Maziarz RT. Perspectives on outpatient administration of CAR-T cell therapy in aggressive B-cell lymphoma and acute lymphoblastic leukemia. J Immunother Cancer 2021; 9:e002056. [PMID: 33846220 PMCID: PMC8047987 DOI: 10.1136/jitc-2020-002056] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 12/05/2022] Open
Abstract
Chimeric antigen receptor (CAR) T-cell therapies that specifically target the CD19 antigen have emerged as a highly effective treatment option in patients with refractory B-cell hematological malignancies. Safety and efficacy outcomes from the pivotal prospective clinical trials of axicabtagene ciloleucel, tisagenlecleucel and lisocabtagene maraleucel and the retrospective, postmarketing, real-world analyses have confirmed high response rates and durable remissions in patients who had failed multiple lines of therapy and had no meaningful treatment options. Although initially administered in the inpatient setting, there has been a growing interest in delivering CAR-T cell therapy in the outpatient setting; however, this has not been adopted as standard clinical practice for multiple reasons, including logistic and reimbursement issues. CAR-T cell therapy requires a multidisciplinary approach and coordination, particularly if given in an outpatient setting. The ability to monitor patients closely is necessary and proper protocols must be established to respond to clinical changes to ensure efficient, effective and rapid evaluation either in the clinic or emergency department for management decisions regarding fever, sepsis, cytokine release syndrome and neurological events, specifically immune effector cell-associated neurotoxicity syndrome. This review presents the authors' institutional experience with the preparation and delivery of outpatient CD19-directed CAR-T cell therapy.
Collapse
Affiliation(s)
- G Doug Myers
- Division of Hematology/Oncology/Cellular Therapy and Stem Cell Transplantation, Children's Mercy Hospital; University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Michael R Verneris
- Cancer and Blood Disorders, Section of Blood and Marrow Transplantation and Cellular Therapy, University of Colorado, Denver, Colorado, USA
| | - Andre Goy
- Division of Lymphoma, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Richard T Maziarz
- BMT & Cell Therapy Program, Division of Hematology/Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
| |
Collapse
|
6
|
Sesques P, Ferrant E, Safar V, Wallet F, Tordo J, Dhomps A, Karlin L, Brisou G, Vercasson M, Hospital‐Gustem C, Schwiertz V, Ranchon F, Rioufol C, Choquet M, Sujobert P, Ghergus D, Bouafia F, Golfier C, Lequeu H, Lazareth A, Novelli S, Devic P, Traverse Glehen A, Viel S, Venet F, Mialou V, Hequet O, Chauchet A, Arkam Y, Nicolas‐Virelizier E, Peyrade F, Cavalieri D, Ader F, Ghesquières H, Salles G, Bachy E. Commercial anti-CD19 CAR T cell therapy for patients with relapsed/refractory aggressive B cell lymphoma in a European center. Am J Hematol 2020; 95:1324-1333. [PMID: 32744738 DOI: 10.1002/ajh.25951] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/08/2020] [Accepted: 07/28/2020] [Indexed: 11/07/2022]
Abstract
Two autologous anti-CD19 chimeric antigen receptors (CAR) T cells (axicabtagene ciloleucel [axi-cel] and tisagenlecleucel [tisa-cel]) are commercially approved in Europe for relapsed/refractory (R/R) diffuse large B cell lymphoma (DLBCL). We performed a retrospective study to evaluate patterns of use, efficacy and safety for axi-cel and tisa-cel. Data from 70 patients who underwent apheresis for commercial CAR T cells between January 2018 and November 2019 in our institution were retrospectively collected. Sixty-one patients were infused. The median age at infusion was 59 years old (range 27-75 years). The median number of prior therapies was 3 (range, 2-6). The overall response rates (ORRs) at 1 month and 3 months were 63% and 45%, respectively, with 48% and 39% achieving a complete response (CR), respectively. After a median follow-up after infusion of 5.7 months, the median progression-free survival (PFS) was 3.0 months (95% CI, 2.8-8.8 months), and the median overall survival (OS) was 11.8 months (95% CI, 6.0-12.6 months). In multivariate analysis, factors associated with poor PFS were the number of previous lines of treatment before CAR T cells (≥4) (P = .010) and a C reactive protein (CRP) value >30 mg/L at the time of lymphodepletion (P < .001). Likewise, the only factor associated with a shorter OS was CRP >30 mg/L (P = .009). Cytokine release syndrome (CRS) of any grade occurred in 85% of patients, including 8% of patients with CRS of grade 3 or higher. Immune cell-associated neurotoxicity syndrome (ICANS) of any grade occurred in 28% of patients, including 10% of patients with ICANS of grade 3 or higher. Regarding efficacy and safety, no significant difference was found between axi-cel and tisa-cel. This analysis describes one of the largest real-life cohorts of patients treated with axi-cel and tisa-cel for R/R aggressive B cell lymphoma in Europe.
Collapse
Affiliation(s)
- Pierre Sesques
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
- Claude Bernard Lyon 1 University Lyon France
| | - Emmanuelle Ferrant
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Violaine Safar
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Florent Wallet
- Department of Critical Care Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Jérémie Tordo
- Department of Nuclear Medicine Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Anthony Dhomps
- Department of Nuclear Medicine Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Lionel Karlin
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Gabriel Brisou
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
- Claude Bernard Lyon 1 University Lyon France
| | - Marlène Vercasson
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Carole Hospital‐Gustem
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Vérane Schwiertz
- Department of Pharmacy Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Florence Ranchon
- Claude Bernard Lyon 1 University Lyon France
- Department of Pharmacy Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Catherine Rioufol
- Claude Bernard Lyon 1 University Lyon France
- Department of Pharmacy Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Marion Choquet
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Pierre Sujobert
- Claude Bernard Lyon 1 University Lyon France
- Department of Hematology Laboratory Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
- Lyon Cancer Research Center INSERM U1052 and CNRS UMR5286 Lyon France
| | - Dana Ghergus
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Fadhela Bouafia
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Camille Golfier
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
- Claude Bernard Lyon 1 University Lyon France
| | - Helène Lequeu
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Anne Lazareth
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Silvana Novelli
- Lyon Cancer Research Center INSERM U1052 and CNRS UMR5286 Lyon France
| | - Perrine Devic
- Department of Neurology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Alexandra Traverse Glehen
- Claude Bernard Lyon 1 University Lyon France
- Lyon Cancer Research Center INSERM U1052 and CNRS UMR5286 Lyon France
- Department of Pathology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Sébastien Viel
- Claude Bernard Lyon 1 University Lyon France
- Department of Biological Immunology Hospices Civils de Lyon, Lyon Sud Hospital Lyon France
- International Center for Research in Infectious Diseases INSERM U1111 and CNRS UMR5308 Lyon France
| | - Fabienne Venet
- Claude Bernard Lyon 1 University Lyon France
- Department of Clinical Immunology Hospices Civils de Lyon, Edouard Herriot Hospital Lyon France
| | - Valérie Mialou
- Department of Biology and Therapy Etablissement Français du Sang Auvergne‐Rhône‐Alpes Decines‐Charpieu France
| | - Olivier Hequet
- Department of Biology and Therapy Etablissement Français du Sang Auvergne‐Rhône‐Alpes Decines‐Charpieu France
| | - Adrien Chauchet
- Department of Hematology Besançon University Hospital Besançon France
| | - Yazid Arkam
- Department of Hematology Hopital Emile Muller Mulhouse France
| | | | | | - Doriane Cavalieri
- Department of Hematology Clermont Ferrand University Hospital Clermont Ferrand France
| | - Florence Ader
- Department of Infectious Disease Hospices Civils de Lyon, Croix Rousse Hospital Lyon France
| | - Hervé Ghesquières
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
- Claude Bernard Lyon 1 University Lyon France
- Lyon Cancer Research Center INSERM U1052 and CNRS UMR5286 Lyon France
| | - Gilles Salles
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
- Claude Bernard Lyon 1 University Lyon France
- Lyon Cancer Research Center INSERM U1052 and CNRS UMR5286 Lyon France
| | - Emmanuel Bachy
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
- Claude Bernard Lyon 1 University Lyon France
- Lyon Cancer Research Center INSERM U1052 and CNRS UMR5286 Lyon France
| |
Collapse
|
7
|
Real world experience of approved chimeric antigen receptor T-cell therapies outside of clinical trials. Curr Res Transl Med 2020; 68:159-170. [DOI: 10.1016/j.retram.2020.05.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/17/2020] [Accepted: 05/20/2020] [Indexed: 12/11/2022]
|
8
|
Greenbaum U, Mahadeo KM, Kebriaei P, Shpall EJ, Saini NY. Chimeric Antigen Receptor T-Cells in B-Acute Lymphoblastic Leukemia: State of the Art and Future Directions. Front Oncol 2020; 10:1594. [PMID: 32984022 PMCID: PMC7480185 DOI: 10.3389/fonc.2020.01594] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/23/2020] [Indexed: 12/24/2022] Open
Abstract
Use of adoptive T-cell therapy modified with chimeric antigen receptor (CAR-T) has revolutionized treatment of patients with relapsed/refractory (r/r) B-cell acute lymphoblastic leukemia (B-ALL). CAR-T cells directed against CD19 antigen have produced response rates as high as 90% in clinical trials for r/r B-ALL. Despite high rates of complete remissions, the durability of responses has been sub-optimal with frequent relapses, especially in adult B-ALL population. Systemic toxicities from CAR-T therapy and standardization of toxicities grading and management is another major hurdle in the development of CAR-T field. In this review, we discuss the latest evidence of CAR-T therapy in B-ALL, potential mechanisms of relapse and barriers to CAR-T cell therapy in B-ALL. We also debate the role of allogeneic hematopoietic stem cell transplant (allo-HCT) post CAR-T therapy.
Collapse
Affiliation(s)
- Uri Greenbaum
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kris Michael Mahadeo
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Partow Kebriaei
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Elizabeth J Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Neeraj Y Saini
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| |
Collapse
|
9
|
Pantin J, Battiwalla M. Upsetting the apple CAR-T (chimeric antigen receptor T-cell therapy) - sustainability mandates USA innovation. Br J Haematol 2020; 190:851-853. [PMID: 32358811 DOI: 10.1111/bjh.16685] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/02/2020] [Indexed: 11/28/2022]
Abstract
Seldom has a medical advance in cancer therapy been as pivotal as the advent of chimeric antigen receptor (CAR)-T-cell immunotherapy. While the first applications targeted the CD19 antigen on lymphoid malignancies, the incredible specificity of these 'living drugs', curative potential and generalisability to other targets have richly justified their declaration as 2019's breakthrough of the year by Science magazine. Two CAR-T products, Yescarta (axicabtagene ciloleucel) and Kymriah (tisagenlecleucel) were Food and Drug Administration (FDA)-approved in the USA in late 2017, with the FDA commissioner Scott Gottlieb heralding 'a new frontier in medical innovation with the ability to reprogram a patient's own cells to attack a deadly cancer'. Building upon early enthusiasm, nearly 1000 cell- and gene-therapy investigational new drug applications are pending with the FDA, which expects to review and approve between 10 and 20 such treatments annually by 2025. Despite the enormous promise and urgent unmet need fulfilled by CAR-T cells, the real-world adoption of the two FDA-approved treatments has been slow.
Collapse
Affiliation(s)
- Jeremy Pantin
- Sarah Cannon Blood Cancer Network, Nashvislle, TN, USA
| | | |
Collapse
|
10
|
Schuster SJ, Maziarz RT, Rusch ES, Li J, Signorovitch JE, Romanov VV, Locke FL, Maloney DG. Grading and management of cytokine release syndrome in patients treated with tisagenlecleucel in the JULIET trial. Blood Adv 2020; 4:1432-1439. [PMID: 32271899 PMCID: PMC7160283 DOI: 10.1182/bloodadvances.2019001304] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/22/2020] [Indexed: 01/24/2023] Open
Abstract
Chimeric antigen receptor T-cell (CAR-T) therapy yields durable responses in patients with relapsed/refractory diffuse large B-cell lymphoma (r/r DLBCL). Cytokine release syndrome (CRS) is a CAR-T therapy-related adverse event. To date, clinical trials of different CAR-T products have not been aligned on CRS grading scales and management algorithms. We assessed concordance between the Penn, Lee, and American Society for Transplantation and Cellular Therapy (ASTCT) grading systems by retrospectively regrading CRS events in the JULIET (A Phase 2, Single Arm, Multicenter Trial to Determine the Efficacy and Safety of CTL019 in Adult Patients With Relapsed or Refractory DLBCL) trial. Four medical experts with experience treating patients with 3 different CAR-T products independently regraded individual patient-level CRS events from the phase 2, global, pivotal JULIET trial (#NCT02445248). As of 8 December 2017, a total of 111 patients with r/r DLBCL underwent infusion with tisagenlecleucel. Sixty-four patients had CRS events graded per the Penn scale; on retrospective review, 63 and 61 patients had CRS events regraded per the Lee and ASTCT criteria, respectively. The Lee scale yielded concordance for 39, lower grade for 20, and higher grade for 5 events compared with the Penn scale. The ASTCT criteria provided concordance for 37, lower grade for 23, and higher grade for 4 events compared with the Penn scale. Sixteen (14%) of 111 patients in the JULIET trial received tocilizumab, all for severe events (Penn grade 3/4 CRS). This study is the first to assess concordance between 3 CRS grading scales using the same patient data set and to compare tocilizumab use according to the Lee scale in the JULIET trial and the ZUMA-1 (Long-Term Safety and Activity of Axicabtagene Ciloleucel in Refractory Large B-Cell Lymphoma) trial. This analysis describes key differences between grading scales and may inform CRS management practices.
Collapse
Affiliation(s)
- Stephen J Schuster
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Richard T Maziarz
- Center for Hematologic Malignancies, Oregon Health & Science Knight Cancer Institute, Portland, OR
| | | | | | | | | | | | | |
Collapse
|
11
|
Pacenta HL, Laetsch TW, John S. CD19 CAR T Cells for the Treatment of Pediatric Pre-B Cell Acute Lymphoblastic Leukemia. Paediatr Drugs 2020; 22:1-11. [PMID: 31749131 DOI: 10.1007/s40272-019-00370-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The development of cluster of differentiation (CD)-19-targeted chimeric antigen receptor (CAR) T cells for the treatment of pre-B-cell acute lymphoblastic leukemia (B-ALL) is an exciting new advancement in the field of pediatric oncology. Tisagenlecleucel and axicabtagene ciloleucel are the first US FDA-approved CD19-targeted CAR T cells. While various different CD19 CAR T cells are in development, tisagenlecleucel is the only CAR T cell approved for pediatric patients. The multicenter phase II trial that led to the approval of tisagenlecleucel demonstrated excellent responses in individuals with highly refractory disease. Other high-risk groups of patients with B-ALL who experience poor outcomes with standard therapy may also benefit from treatment with tisagenlecleucel. After receiving CAR T cells, patients must be closely monitored for unique toxicities, including cytokine release syndrome, neurotoxicity, and B-cell aplasia. The management of patients with relapsed or refractory disease after administration of CD19 CAR T cells can be challenging, and treatment options vary according to the characteristics of the disease present at relapse. In the many patients who experience a complete response, CAR T cells can lead to a durable remission. This review describes the current design and manufacturing of CAR T cells. Data in the selection and management of pediatric patients are highlighted, as are areas where further studies are needed.
Collapse
Affiliation(s)
- Holly L Pacenta
- Division of Pediatric Hematology-Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9063, USA
- The Pauline Allen Gill Center for Cancer and Blood Disorders, Children's Health, Dallas, TX, USA
| | - Theodore W Laetsch
- Division of Pediatric Hematology-Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9063, USA.
- The Pauline Allen Gill Center for Cancer and Blood Disorders, Children's Health, Dallas, TX, USA.
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9063, USA.
| | - Samuel John
- Division of Pediatric Hematology-Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9063, USA
- The Pauline Allen Gill Center for Cancer and Blood Disorders, Children's Health, Dallas, TX, USA
| |
Collapse
|
12
|
Cahill KE, Leukam MJ, Riedell PA. Refining patient selection for CAR T-cell therapy in aggressive large B-cell lymphoma. Leuk Lymphoma 2019; 61:799-807. [DOI: 10.1080/10428194.2019.1691201] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Kirk E. Cahill
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Michael J. Leukam
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Peter A. Riedell
- Hematopoietic Cellular Therapy Program, Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| |
Collapse
|