Swetha Kambhampati, MD, on the Potential of Bringing Brexu-cel to Earlier Treatment Settings

“I think at least in this largest real-world study to date, the findings support considering use of brexu-cel in earlier lines because we saw higher response rates in patients who are less heavily pretreated even when adjusting for other baseline characteristics... In the multivariate analysis, we found a higher likelihood of achieving complete response in patients who had 1 to 2 prior lines [of therapy, compared to patients who had 3 or more lines]. This suggests that using this therapy earlier may improve outcomes. Of course, this needs further evaluation, but I think, mechanistically, it's reasonable and makes sense. Patients, when they're less heavily pretreated, have improved T-cell quality, and this may impact the outcomes of brexu-cel.”

Kite Pharma’s brexucabtagene autoleucel (brexu-cel, Tecartus) is a chimeric antigen receptor T-cell (CAR-T) therapy currently FDA-approved for use in the second-line setting for adult patients with mantle cell lymphoma (MCL).¹ Its approval in MCL was based on results from the phase 2 ZUMA-2 clinical trial (NCT02601313). Notably, all patients in ZUMA-2 had received prior treatment with BTK inhibitor; however, the FDA indication for brexu-cel does not require a specific prior treatment regimen.² As such, in real-world settings, the treatment histories of patients with MCL receiving brexu-cel are more varied.

Swetha Kambhampati, MD, an assistant professor in the Division of Lymphoma at City of Hope, gave a talk entitled “Real-world outcomes of brexucabtagene autoleucel (brexu-cel) for relapsed or refractory (r/r) mantle cell lymphoma (MCL): A CIBMTR subgroup analysis by prior treatment” at the American Society of Clinical Oncology (ASCO) 2023 Annual Meeting, held June 2-6, in Chicago, Illinois. The talk covered an analysis of real-world outcomes from a subgroup of 380 patients who received brexu-cel and were registered in the Center for International Blood and Marrow Transplant Research (CIBMTR) observational database.

In an interview with CGTLive™’s sister publication OncLive™, Kambhampati gave an overview of the data she presented at the conference, noting that in multivariate analysis, patients who had received only 1 to 2 prior lines of therapy had 2-fold higher chances of achieving a complete response versus patients who had received 3 or more prior lines of therapy. She also discussed the implications of the results, suggesting that they could provide support for investigating the possibility of bringing brexu-cel into earlier treatment settings. Although, she emphasized that more research and longer follow-up times are needed.

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REFERENCES
1. U.S. FDA Approves Kite’s Tecartus™, the first and only CAR T treatment for relapsed or refractory mantle cell lymphoma. News release. Kite, a Gilead Company. July 24, 2020. Accessed June 20, 2023. https://www.businesswire.com/news/home/20200724005428/en/
2. Kambhampati S, Ahmed N, Hamadani M, et al. Real-world outcomes of brexucabtagene autoleucel (brexu-cel) for relapsed or refractory (r/r) mantle cell lymphoma (MCL): A CIBMTR subgroup analysis by prior treatment. Presented at: the American Society of Clinical Oncology (ASCO) 2023 Annual Meeting, held June 2-6, in Chicago, Illinois. Abstract #7507