Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
University of Iowa, Iowa City, Iowa, USA.
Oncologist. 2020 Jan;25(1):e138-e146. doi: 10.1634/theoncologist.2019-0395. Epub 2019 Oct 4.
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. IMPLICATIONS FOR PRACTICE: Community oncologists should be familiar with key aspects of chimeric antigen receptor (CAR) T-cell indications and eligibility to help recognize and refer potential patients for this paradigm-changing treatment option at the appropriate time during the disease course. To ensure optimal long-term outcomes for patients who have been treated with CAR T-cell therapy, oncologists must also be familiar with common prolonged AEs and their monitoring and management.
阿基仑赛注射液是首个获得美国食品和药物管理局批准的用于治疗接受≥2 种系统治疗后复发或难治性大 B 细胞淋巴瘤的自体抗 CD19 嵌合抗原受体(CAR)T 细胞疗法。尽管阿基仑赛注射液仅在授权的治疗中心使用,但社区肿瘤学家在 CAR T 细胞治疗过程中发挥着至关重要的作用,他们识别出有资格接受转诊的潜在合格患者,然后在治疗后与治疗中心密切合作,长期监测和管理患者。ZUMA-1 是一项多中心、关键性的 I/II 期研究,共纳入 108 例接受阿基仑赛注射液治疗的患者,客观缓解率为 83%,完全缓解率为 58%。中位随访 27.1 个月时,39%的患者持续缓解。CAR T 细胞疗法与细胞因子释放综合征和神经事件等潜在危及生命的不良事件(AE)相关,这些事件通常发生在治疗后早期。在 ZUMA-1 中,细胞因子释放综合征和神经事件通常是可逆的,分别有 11%和 32%的患者发生≥3 级细胞因子释放综合征和神经事件。常见的持续性 AE 包括低丙种球蛋白血症、B 细胞发育不全和需要支持治疗的细胞减少症,直到造血功能恢复。治疗相关死亡率较低,<2%。通过对常见 AE 的适当管理,阿基仑赛注射液为那些缺乏治愈性治疗选择的患者提供了长期持久缓解的潜力。对实践的意义:社区肿瘤学家应熟悉嵌合抗原受体(CAR)T 细胞适应证和资格的关键方面,以便在疾病过程中的适当时间识别和转介潜在患者,以获得这种改变治疗模式的治疗选择。为了确保接受 CAR T 细胞治疗的患者获得最佳的长期结局,肿瘤学家还必须熟悉常见的持续性 AE 及其监测和管理。
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