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
Narjust Florez, MD, of Dana-Farber Cancer Institute, and David R. Spigel, MD, of Sarah Cannon Research Institute, discuss phase III findings showing that durvalumab as consolidation treatment after concurrent platinum-based chemoradiotherapy improved survival outcomes compared with placebo in patients with limited-stage small cell lung cancer. According to Dr. Spigel, these data support durvalumab as a new standard of care in this population (Abstract LBA5).
The ASCO Post Staff
Laurence Albiges, MD, PhD, of Gustave Roussy, Université Paris-Saclay, discusses phase III findings showing that high baseline serum KIM-1 levels were associated with poorer prognosis but improved clinical outcomes with atezolizumab vs placebo in patients with renal cell carcinoma at increased risk of recurrence after resection. Increased post-treatment KIM-1 levels were found to be associated with worse disease-free survival (Abstract 4506).
The ASCO Post Staff
Jean-Marc Classe, MD, PhD, of France’s Nantes Université, discusses phase III results showing that systematic lymphadenectomy should be omitted in patients with advanced epithelial ovarian cancer with clinically negative lymph nodes, as well as those undergoing neoadjuvant chemotherapy and interval complete surgery (LBA5505).
The ASCO Post Staff
Yeon Hee Park, MD, PhD, of South Korea’s Samsung Medical Center and Sungkyunkwan University, discusses phase II findings on palbociclib plus exemestane with a GnRH agonist vs capecitabine in premenopausal patients with hormone receptor–positive, HER2-negative metastatic breast cancer (LBA1002).
The ASCO Post Staff
Jonathan E. Rosenberg, MD, of Memorial Sloan Kettering Cancer Center, and Thomas Powles, MD, PhD, of Barts Cancer Institute and the University of London, discuss phase III findings from two studies: the first, investigating enfortumab vedotin-ejfv and pembrolizumab vs platinum-based chemotherapy in previously untreated patients with locally advanced or metastatic urothelial cancer; and the second, looking at nivolumab plus gemcitabine and cisplatin vs gemcitabine and cisplatin alone in patients with lymph node–only metastatic disease enrolled in the CheckMate 901 trial (Abstracts 4581 and 4565).