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JTCC Investigators Participated in ZUMA-2 Study Leading to FDA Approval of First CAR T-Cell Therapy for Recurrent/Persistent Mantle Cell Lymphoma

John Theurer Cancer CenterOncology

What you need to know

The U.S. Food and Drug Administration granted accelerated approval for brexucabtagene autoleucel (TECARTUS™, formerly KTE-X19) as the first and only CAR T-cell therapy for patients with mantle cell lymphoma (MCL) relapsed or refractory to prior treatments.

Investigators from John Theurer Cancer Center (JTCC) participated in the ZUMA-2 clinical trial, which assessed the safety and effectiveness of brexucabtagene autoleucel in patients with relapsed or refractory MCL who had received up to five prior regimens of treatment and had exhausted all other therapies.

That transformative study showed that 93% of patients responded to treatment, with 67% achieving a complete response (no evidence of disease). The data were published in the April 2, 2020 issue of the New England Journal of Medicine.

“The overall response rate (93%) particularly complete response (no evidence of disease) seen in over 2/3 of patients is unprecedented in that setting. In addition, though the follow up is short, over 75% of the complete responders were still in response at 12 months. Furthermore, among a subset of patients tested for minimal residual disease (83%) had no detectable residual disease.”

Andre Goy, M.D., M.S., chairman and director of JTCC, Lymphoma Division chief, physician-in-chief of the Hackensack Meridian Health Oncology Care Transformation Service

Results of the ZUMA-2 Study

The ZUMA-2 study included people with MCL whose cancer came back or continued to grow despite having previously received chemoimmunotherapy and drugs called BTK inhibitors, such as ibrutinib or acalabrutinib. After a single infusion of brexucabtagene autoleucel, 93% of patients experienced a reduction in their cancer and 67% achieved a complete response. These findings persisted regardless of the number of prior therapies or the extent of a patient’s disease. Notably, 40% of patients who initially had a partial response or stable disease (no reduction in cancer, but also no growth) went on to achieve a complete response within 3 to 12 months of the infusion.

Moreover, the patients’ responses were also durable. At one year, estimated progression-free survival (the time before the cancer continues to grow) and overall survival were 61% and 83%, respectively. After a median follow-up of 12.3 months, 57% of patients remained in remission. For the first 28 patients who were treated with KTE-X19) and had the longest follow-up time (median 27 months), 43% of the responders remained in remission — a rate totally unprecedented for this population of patients.

Side Effects

Side effects of treatment were generally manageable and as expected with CAR T-cell therapy. These included cytokine release syndrome (a release of inflammatory proteins related to the immune response), low blood cell counts, and nervous system side effects — all of which were reversible.

MCL is an aggressive form of non-Hodgkin lymphoma that is very challenging to treat: patients typically respond to initial therapy but almost inevitably relapse and become resistant to therapy over time with then very poor outcome.

More Details about CAR T-Cell Therapy

CAR T-cell therapy is a form of treatment which involves removing white blood cells called T cells from the patient, modifying them in the laboratory to train them to see a protein (CD19) on lymphoma cells, and then multiplying them to much larger numbers. When given back to the patient intravenously, they expand further, identifying and killing cancer cells anywhere in the body. Two other forms of CAR T-cell therapy — axi-cell (Yescarta®) and tisa-cell (Kymriah®) — were previously approved by the U.S. Food and Drug Administration to treat recurrent and persistent B-cell lymphoma in adults, as well as acute lymphoblastic leukemia in children and young adults up to age 25. Brexucabtagene autoleucel is the first CAR T-cell therapy approved to treat patients with MCL.