Saturday, May 27, 2017
(We’re taking a quick break from ASCO Previews for this one. The review is based on results that were presented at a different convention — the AACR last month. The results come from the phase 2 ZUMA-1 trial, though a few other different aspects of that trial will be discussed at ASCO.)
CAR-T therapies, in general, involve removing T cells from the patient. T cells are part of the immune system, and their job is to find invaders (like cancer cells) and get rid of them. The problem is, T cells can’t recognize cancer cells. So after the T cells are removed, they are changed so they will recognize the cancer cells, and then they are put back into the patient so they can do their job.
Now, KTE-C19 works the same way. It gets its name from its target: the protein called CD19, which appears on the surface of the cancer cells being targeted (and lots of other cells). When those new, changed T cells find the cancer cells, they destroy them, the way they were supposed to.
The Zuma-1 trial looked at two groups of patients, one of them including transformed FL patients. Out of 101 total patients, 24 of them had transformed FL or another type of lymphoma. In that group, the Overall Response rate was 83%, and the Complete Response rate was 71%. After 8.7 months, the OR rate remained high — 67%, and the CR stayed at 61%.
Patients in the trial were chemorefractory, meaning chemotherapy was no longer working for them. They had had a median of 3 treatments before the trial.
Side effects included things like anemia, decreased white blood cell counts of different types. Several patients had Cytokine Release Syndrome, which occurs when the body is overwhelmed with an immune response. There were 4 fatalities during the trial, 3 of them related to the treatment. Most of the non-fatal side effects were reversed within a month.
Based on these results, the FDA is granting Priority Review (as it did with Copanlisib earlier this month). This means that the FDA plans to take action on approval within 6 months, and that it considers the treatment important enough (and doing something that other treatments aren’t doing) to speed it along a few months early.
If this is approved, it will give us another tool for transformed Follicular Lymphoma — we can never have too many.
CAR-T is definitely hot this year at ASCO, with trials and experiments targeting a bunch of different cancers. I know there are a few folks who read regularly who have some experience with it, and who are very excited about CAR-T. Let’s hope this one continues to give us all something else to be excited about.
More about the potentially dangerous CRS from the perspective of nurses’ training:
At some point in the near future I will create a formal “resources” page, perhaps with a link in the sidebar (as soon as I can figure out how to do that!). But for now, I just want to list a few places I’ve been frequenting, where I’ve made acquaintances with other patients who are in similar circumstances:
Facebook (I finally see value in Facebook!) :
My twitter handle is: @BenXM
You can see all the lymphoma and CAR-T specialists I follow using this link:
I’ve also been bookmarking interesting CAR-T and lymphoma links here:
Please leave a comment if you’re having any trouble following any of the links in this post.
For those who haven’t yet seen this, this occurred a few days ago. Apparently this patient’s lymphoma was very advanced. There seems to be a high correlation between degree of disease and severity of Cytokine Release Syndrome (CRS). We’ll have to wait and see what this means for Kite Pharmaceuticals’ request for FDA approval for their CAR-T program.
One of Kite Pharma’s CAR-T patients died from cerebral edema, triggering a safety alarm – ENDPOINTS NEWS
Kite CAR-T Death: An Unwelcome Mystery as FDA Mulls Approval | Xconomy
Kite Pharma Discloses CAR-T Patient Death, Rattling Investors – TheStreet
Investors spooked by Kite CAR-T death, but biotech remains confident | FierceBiotech