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Overview of approved CAR-T therapies, ongoing clinical trials, and its impact on clinical practice.
Literature Information
| DOI | 10.1002/jha2.338 |
|---|---|
| PMID | 35844299 |
| Journal | EJHaem |
| Impact Factor | 1.2 |
| JCR Quartile | Q4 |
| Publication Year | 2022 |
| Times Cited | 71 |
| Keywords | CAR‐T cell therapy, acute lymphoblastic leukemia, diffuse large B‐cell lymphoma, multiple myeloma, non‐Hodgkin lymphoma |
| Literature Type | Journal Article, Review |
| ISSN | 2688-6146 |
| Pages | 6-10 |
| Issue | 3(Suppl 1) |
| Authors | Salyka Sengsayadeth, Bipin N Savani, Olalekan Oluwole, Bhagirathbhai Dholaria |
TL;DR
This review discusses the rapid advancement of chimeric antigen receptor T-cell (CAR-T) therapies, particularly their transformative impact on treating non-Hodgkin lymphoma, B-cell acute lymphoblastic leukemia, and multiple myeloma, showing high response rates and potential for durable remissions. It emphasizes the ongoing exploration of CAR-T therapy in earlier treatment lines and its potential to replace traditional methods like autologous hematopoietic cell transplantation, while also highlighting the development of therapies targeting novel tumor-associated antigens to broaden its applications in hematological malignancies.
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CAR‐T cell therapy · acute lymphoblastic leukemia · diffuse large B‐cell lymphoma · multiple myeloma · non‐Hodgkin lymphoma
Abstract
In recent years, we have seen rapid expansion of chimeric antigen receptor T-cell (CAR-T) therapies in multiple malignancies. CAR-T therapy has profoundly altered the treatment landscape of non-Hodgkin lymphoma, B-cell acute lymphoblastic leukemia, and multiple myeloma. Currently available CD19 and B-cell maturation antigen-directed CAR-T therapies have shown high overall response rate and durable remissions in patients who have failed standard therapies. Multiple studies are underway exploring the role of CAR-T-cell therapy as earlier line of treatment. In high-grade B-cell lymphoma, CD19 CAR-T therapy may replace autologous hematopoietic cell transplantation as second line therapy in near future. CAR-T-cell therapy targeting novel tumor-associated antigens will help expand utility of this treatment modality in other hematological malignancies. It may also help overcome limitations of currently approved CAR-T-cell therapies. In this review, we have provided an overview of currently approved CAR-T therapies and upcoming clinical trials which may potentially impact the clinical practice.
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Primary Questions Addressed
- What are the key differences in efficacy and safety between currently approved CAR-T therapies and those in clinical trials?
- How might the integration of CAR-T therapy into earlier lines of treatment affect patient outcomes compared to traditional therapies?
- What novel tumor-associated antigens are being targeted in upcoming CAR-T therapies, and what implications do they have for treatment expansion?
- In what ways could CAR-T therapy evolve to address the limitations faced by current therapies in terms of patient eligibility and treatment response?
- How do ongoing clinical trials aim to refine the administration protocols of CAR-T therapies to enhance their effectiveness in diverse patient populations?
Key Findings
Research Background and Purpose
Chimeric antigen receptor T-cell (CAR-T) therapies have emerged as a groundbreaking treatment modality for various hematological malignancies, particularly non-Hodgkin lymphoma (NHL), B-cell acute lymphoblastic leukemia (B-ALL), and multiple myeloma (MM). This review aims to provide a comprehensive overview of currently approved CAR-T therapies, ongoing clinical trials, and their impact on clinical practice, highlighting advancements in CAR-T technology and its potential to alter treatment paradigms.
Main Methods/Materials/Experimental Design
The review systematically discusses FDA-approved CAR-T therapies, focusing on their development, mechanisms of action, clinical trial results, and safety profiles.
Key Results and Findings
FDA-Approved Therapies:
- Axicabtagene ciloleucel (axi-cel): Approved for R/R high-grade B-cell lymphoma with an overall response rate (ORR) of 82% and a complete response (CR) rate of 54%.
- Tisagenlecleucel (tisa-cel): Approved for R/R B-ALL in pediatric and young adults, showing an ORR of 81% and a CR rate of 75%.
- Lisocabtagene maraleucel (liso-cel): Achieved a 73% ORR and 54% CR in R/R large B-cell lymphoma.
- Brexucabtagene autoleucel (brexu-cel): Approved for R/R mantle cell lymphoma with an ORR of 93% and a CR rate of 67%.
Ongoing Clinical Trials:
- Numerous studies are investigating the efficacy of CAR-T therapies in earlier lines of treatment and targeting novel antigens, which may expand the applicability of CAR-T therapies.
Main Conclusions/Significance/Innovation
CAR-T therapies represent a significant advancement in the treatment of hematological malignancies, offering high response rates and durable remissions in patients with limited treatment options. The potential shift towards using CAR-T therapies as first-line treatments and the exploration of novel targets may enhance the effectiveness of these therapies, addressing the limitations of existing treatments. The review emphasizes the transformative impact of CAR-T therapies on clinical practice, with the potential to improve patient outcomes and quality of life.
Research Limitations and Future Directions
While CAR-T therapies have shown promise, challenges remain, including:
- Toxicity Management: New toxicities associated with CAR-T therapies, such as cytokine release syndrome (CRS) and neurotoxicity, require ongoing education and adaptation in clinical practice.
- Access and Infrastructure: The need for specialized centers to manage CAR-T therapy patients and the implications for healthcare systems.
- Long-Term Efficacy: Ongoing research is necessary to determine the long-term efficacy and safety of CAR-T therapies, particularly in diverse patient populations.
Future research should focus on:
- Expanding CAR-T applications to additional hematological malignancies.
- Investigating combination therapies to enhance efficacy and reduce toxicity.
- Developing strategies to manage and mitigate adverse effects associated with CAR-T therapies.
References
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Literatures Citing This Work
- Targeting CD10 on B-Cell Leukemia Using the Universal CAR T-Cell Platform (UniCAR). - Nicola Mitwasi;Claudia Arndt;Liliana R Loureiro;Alexandra Kegler;Frederick Fasslrinner;Nicole Berndt;Ralf Bergmann;Vaclav Hořejší;Claudia Rössig;Michael Bachmann;Anja Feldmann - International journal of molecular sciences (2022)
- Overview of approved CAR-T therapies, ongoing clinical trials, and its impact on clinical practice. - Salyka Sengsayadeth;Bipin N Savani;Olalekan Oluwole;Bhagirathbhai Dholaria - EJHaem (2022)
- Chimeric antigen receptor-T cell therapies: The changing landscape. - Salyka M Sengsayadeth;Bhagirathbhai R Dholaria;Bipin N Savani;Olalekan O Oluwole - EJHaem (2022)
- Current updates on generations, approvals, and clinical trials of CAR T-cell therapy. - Tadesse Asmamaw Dejenie;Markeshaw Tiruneh G/Medhin;Gashaw Dessie Terefe;Fitalew Tadele Admasu;Wondwossen Wale Tesega;Endeshaw Chekol Abebe - Human vaccines & immunotherapeutics (2022)
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- Activation of distinct antiviral T-cell immunity: A comparison of bi- and trispecific T-cell engager antibodies with a chimeric antigen receptor targeting HBV envelope proteins. - Bilge Debelec-Butuner;Oliver Quitt;Sophia Schreiber;Frank Momburg;Karin Wisskirchen;Ulrike Protzer - Frontiers in immunology (2022)
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... (61 more literatures)
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