Axicabtagene Ciloleucel, an Anti‐CD19 Chimeric Antigen Receptor T‐Cell Therapy for Relapsed or Refractory Large B‐Cell Lymphoma: Practical Implications for the Community Oncologist. (4th October 2019)

• Record Type: Journal Article
• Authors: Jacobson, Caron A.; Farooq, Umar; Ghobadi, Armin
• Is Part Of: Oncologist. Volume 25:Number 1(2020)
• Page Start: e138
• Page End: e146
• Publication Date: 2019-10-04
• Subjects: Diffuse large B‐cell lymphoma -- Transformed follicular lymphoma -- Primary mediastinal B‐cell lymphoma -- High‐grade B‐cell lymphoma -- Immunotherapy; Oncology -- Periodicals; Tumors -- Periodicals; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Oncology; Tumors; Neoplasms; Electronic journals; Periodicals; Periodicals; 616.994
• DOI: 10.1634/theoncologist.2019-0395
• Languages: English
• ISSNs: 1083-7159

Abstract

Abstract: : Axicabtagene ciloleucel is the first U.S. Food and Drug Administration–approved autologous anti‐CD19 chimeric antigen receptor (CAR) T‐cell therapy for the treatment of patients with relapsed or refractory large B‐cell lymphoma after ≥2 prior systemic therapies. Although axicabtagene ciloleucel is administered only at authorized treatment centers, community oncologists play a critical role in the CAR T‐cell treatment journey, recognizing potentially eligible patients for referral and then, after treatment, closely collaborating with treatment centers to monitor and manage patients long term. ZUMA‐1, the pivotal, multicenter, phase I/II study of 108 patients treated with axicabtagene ciloleucel, resulted in an objective response rate of 83%, including 58% complete responses. With a 27.1‐month median follow‐up, 39% of patients had ongoing responses. CAR T‐cell therapy is associated with the potentially life‐threatening adverse events (AEs) of cytokine release syndrome and neurologic events, which generally occur early after treatment. In ZUMA‐1, cytokine release syndrome and neurologic events were generally reversible and grade ≥3 cytokine release syndrome and neurologic events occurred in 11% and 32% of patients, respectively. Frequent prolonged AEs included hypogammaglobulinemia, B‐cell aplasia, and cytopenias requiring supportive care until recovery of hematopoietic function. Rate of treatment‐related mortality was low, at <2%. With appropriate management of common AEs, axicabtagene ciloleucel offers the potential for long‐term durable responses in patients who otherwise lack curative treatment options. Abstract : This article reviews information relevant to oncologists who are caring for patients who have been treated with CAR T cells or who are considering referring a patient with large B‐cell lymphoma for CAR T‐cell therapy.