By Ann Miller Baker
Some forms of CAR T, one of the most important recent breakthroughs in cancer immunotherapy, appear to be safe for use in patients 65 and older, and its success may be enhanced with "bridging" chemotherapy.
These new insights were gleaned from the clinical trial data of some of the first patients treated with CAR T therapy. Moffitt Cancer Center researcher and medical oncologist Frederick Locke was co-principal investigator of the study, called ZUMA-1, for patients whose diffuse large B-cell lymphoma had returned despite previous therapies. This clinical trial led the U.S. Food and Drug Administration to approve the use of Gilead’s YescartaTM in October of 2017. Locke presented this new analysis of data at the recent annual meeting of the American Society of Clinical Oncology (ASCO) in Chicago.
Named as ASCO’s biggest research breakthrough of 2017, CAR T cell therapy is a personalized gene therapy using a patient’s own immune cells, or T cells, to fight cancer. For this treatment, a patient’s T cells are removed and engineered with additional receptors to help identify, attack and ultimately destroy the cancer cells. The re-engineered T cells are then infused back into the patient’s body in a single treatment, enabling the body’s immune system to better combat the disease.
The ZUMA-1 data were re-examined in several ways, Locke said, including a comparison of patients under age 65 and those 65 and older who were treated with Yescarta for large B-cell lymphoma. "The message is that we can safely give this CAR T therapy to patients who are over 65," said Locke.
Another new insight related to patients’ tumor burden — the amount of lymphoma tumors they had when being infused with Yescarta. Patients with a larger tumor burden did not respond as well as those with fewer tumors. “We think that administering what we call ‘bridging’ chemotherapy after the collection of (their T cells) to manufacture CAR T can reduce that tumor burden and potentially lead to better outcomes,” said Locke.
Moffitt is the only certified treatment center in Florida that can offer two types of CAR T therapies to its patients with diffuse large B-cell lymphoma or acute lymphoblastic leukemia. Moffitt was the first to provide commercially available Yescarta after FDA approval in October of 2017. When the FDA expanded use of Novartis’ KymriahTM to this patient population on April 30, 2018, Moffitt became the first Florida center to offer both CAR T choices to patients. In 2019 alone, nearly 100 patients have been treated with CAR T at Moffitt.
To learn more, watch Dr. Frederick Locke’s video interview from the 2019 ASCO Annual Meeting in Chicago.