Allison M. Winter, MD, on Richter Transformation: New Data on a CAR T-Cell Treatment
2024 ASCO Annual Meeting
Allison M. Winter, MD, of the Cleveland Clinic Taussig Cancer Institute, discusses real-world outcomes with lisocabtagene maraleucel in patients with Richter transformation, a difficult-to-treat population with a poor prognosis. Data from the Center for International Blood and Marrow Transplant Research showed this therapy provided clinical benefit with a high complete response rate (Abstract 7010).
Transcript
Disclaimer: This video transcript has not been proofread or edited and may contain errors.
Richter's Transformation is a feared complication of patients with CLL. It happens in a minority up to 1% of patients, but it's associated with poor outcomes with a historical median overall survival anywhere from three to 12 months. We looked at the use of lysis cell as a commercial infusion just for patients with Richter's Transformation using data from the CIBMTR. The data included 30 patients who received a single infusion of lysis cell commercially, who had at least six months of follow-up until the data cut off of February 2023. We looked at outcome measurements, as well as previous lines of therapy and safety data. It's important to note that many of these patients were high risk. Some of the features that made them high risk included things like 77% of patients had prior therapy for their CLL, prior to the Richter Transformation event. 90% of these were large B-cell lymphoma histologies.
All patients received therapy, obviously for their Richter Transformation before they received their infusion of lysis cell. It's important to note that 83% were refractory to their last line of therapy prior to their lysis cell infusion. Many of these patients had prior therapies with novel agents including BTK inhibitors, BCL-II inhibitors, and even chemoimmunotherapy. Some patients were even dual class exposed to both BCL-II inhibitors and BTKI inhibitors. Two patients even had active CNS disease at the time of the lysis cell infusion. For the patients who had the one-time infusion of lysis cell, 76% was the overall response rate with 66% CR's. And this was a pretty quick response. Most patients had a response by 1.1 months. Of those patients who did have a response and had duration of response data available, 77% had a 12-month duration of response. When we look at the outcomes in more depth, we see that the median progression free survival was not reached.
At six months, it was estimated at 65%. And at 12 months, 54%. All patients had survival data available. The six-month overall survival was 79%. And at 12 months estimated at 67%. It's important to look at safety in these CAR T-cell products, especially in this real world setting. 70% of patients had cytokine release syndrome, but thankfully grade three or higher was low in just 7% of patients. 47% did experience ICANNs, but again, the grade three and higher was lower at 27%. So this is, again, a multi-center real world data set from the CIBMTR, looking at lysis cell infusion commercially. Showing high response rates in long, durable responses in this high risk, difficult to treat Richter's Transformation population. We recognize that larger cohorts and longer follow-up is required to really characterize lysis cell in the future in this population.
The ASCO Post Staff
Yucai Wang, MD, PhD, of the Mayo Clinic, discusses the increased efficacy of combination therapy with pembrolizumab plus a BCR kinase inhibitor compared with pembrolizumab alone in patients with Richter transformation of chronic lymphocytic leukemia (CLL; Abstract 7050).
The ASCO Post Staff
David J. Andorsky, MD, of the Sarah Cannon Research Institute and Rocky Mountain Cancer Centers, discusses EPCORE NHL-6, an ongoing study of patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL). As outpatients, the study participants were given subcutaneous epcoritamab-bysp to see whether they could be safely monitored and cytokine-release syndrome appropriately managed in the outpatient setting (Abstract 7029).
The ASCO Post Staff
Mazyar Shadman, MD, MPH, of Fred Hutchinson Cancer Center, discusses a network meta-analysis showing that zanubrutinib appears to be the most efficacious Bruton’s tyrosine kinase (BTK) inhibitor for patients with high-risk relapsed or refractory chronic lymphocytic leukemia. It offers delayed disease progression and favorable survival and response, compared with alternative BTK inhibitors (Abstract 7048).
The ASCO Post Staff
Efrat Dotan, MD, of Fox Chase Cancer Center, discusses results from the phase II EA2186 trial, the first prospective study aiming to define the optimal treatment approach for vulnerable older adults with newly diagnosed metastatic pancreatic cancer (Abstract 4003).
The ASCO Post Staff
Paula Rodríguez-Otero, MD, PhD, of Spain’s Cancer Center Clínica Universidad de Navarra, and Amrita Y. Krishnan, MD, of the City of Hope Cancer Center, discuss two key studies on B-cell maturation antigen (BCMA)-directed therapies: CARTITUDE-4 on ciltacabtagene autoleucel in patients with functional high-risk multiple myeloma; and DREAMM-7 on belantamab mafodotin-blmf plus bortezomib and dexamethasone vs daratumumab, bortezomib, and dexamethasone in patients with relapsed or refractory disease.