New findings indicate that the standard treatment for lymphoma may soon be changing. CAR-T cell therapy, which is most commonly used for late treatment of diffuse large B-cell lymphoma, may become one of the first lines of treatment for patients with more common lymphomas.
What Is CAR-T Cell Therapy?
CAR-T therapy is a relatively new treatment used for rare blood cancers. This therapy works by targeting the cancer tumor cells and destroying them. These cells also remain in the body for years even after the initial treatment, acting as guards and eliminating any new or stray cancer cells that may appear. This treatment is used for diffuse large B-cell lymphoma, which is the most common form of non-Hodgkin lymphoma. This cancer is diagnosed in around 18,000 people in the United States every year.
At this time, the FDA has approved several CAR-T cell therapies as a later line treatment only, designed for use in patients who have exhausted all other options and continue to be sick. Prior to receiving CAR-T cell therapy, patients will usually have gone through an initial stage of treatment with chemotherapy and antibody drugs. They will also have had failed salvage chemotherapy and a failed stem cell transplant. However, recent studies have shown that these therapies may be more useful if employed earlier and more often.
About the Studies
Two studies recently explored the efficacy of CAR-T therapy in the treatment of lymphomas that have relapsed or become resistant to other treatments. These studies both confirmed that CAR-T cell therapy was more effective in these cases than the current standard treatments, which typically include stem cell transplants and chemotherapy. This represents a significant step forward in the field and could encourage the use of CAR-T cell therapies at earlier stages in the treatment process, rather than as a last resort.
Not all studies have shown that CAR-T cell therapies are beneficial when used earlier. In fact, a similar study conducted around the same time as the two studies mentioned above did not find that CAR-T cell therapy was superior to chemotherapy. However, there were key differences between these studies that could account for the differences in results. Specifically, there were delays in treating patients with CAR-T therapy in the studies with less promising results. There were also differences between the study arms that may have altered the outcome.
Looking into the Future
The FDA is already reviewing an application that would allow the expanded use of Yescarta, one of the CAR-T therapies that has already been approved in the United States. The application is based on a trial conducted by the drug’s manufacturer. Participants in this trial went nearly four times longer than those in the control group without having a serious “event” related to their cancer. There were also a greater number of responses and remissions in the treatment group.
If the FDA ultimately approves this application, the use of CAR-T therapy will expand. It is likely that even more expansion will take place as researchers continue to study this therapy.