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Lysosomal Disorders

Oncology

1rem

Authors

Chief of the leukemia service and professor of oncology at the Roswell Park Comprehensive Cancer Center

Eunice Wang, MD, and Bijal Shah, MD, MS, discussed unmet needs for adult patients with relapsed/refractory ALL and reflect on the current treatment landscape.

The Potential of CAR T-Cell Therapy in Adult ALL

Bijal Shah, MD, MS, and Eunice Wang, MD, discussed the use of clinical endpoints like CR, CRi, and CRh as they relate to the ZUMA-3 trial of CAR T cell therapy.

The Use of Clinical Endpoints in the ZUMA-3 Trial

Bijal Shah, MD, MS, and Eunice Wang, MD, discuss efficacy results of the ZUMA-3 trial of chimeric antigen receptor (CAR) T-cell therapy for acute lymphocytic leukemia (ALL), and review key safety data.

Safety and Efficacy of the ZUMA-3 Trial

Eunice Wang, MD, and Bijal Shah, MD, MS, discuss the overall study design and patient population of the ZUMA-3 trial of CAR T-cell therapy in adult patients with R/R ALL.


ZUMA Trial of CAR T-Cell Therapy in R/R ALL

Eunice Wang, MD, and Bijal Shah, MD, MS, discussed the use of MRD status to assess therapeutic response and guide treatment decisions in patients with relapsed/refractory ALL.  

Using MRD to Monitor CAR T Response in ALL

Eunice Wang, MD and Bijal Shah, MD, MS, discuss novel agents and emerging therapeutic approaches for the treatment of acute lymphoblastic leukemia.  

The Role of CAR-T in the ALL Treatment Landscape

Patient use of the 2 FDA-approved gene therapy products for sickle cell disease (SCD), Vertex Pharmaceuticals' and CRISPR Therapeutics’ 

 (exa-cel; marketed as Casgevy) and bluebird bio’s 

 (lovo-cel; marketed as Lyfgenia), in the commercial setting has remained low.

Despite the approval of both gene therapy products by the FDA occurring simultaneously on December 8, 2023, only 4 patients have begun treatment with lovo-cel in the commercial setting, while 20 patients are reported to have begun treatment with exa-cel. Alongside the number for lovo-cel, bluebird also pointed out that this year 4 patients have started on elivaldogene autotemcel (Lenti-D, Skysona), its marketed gene therapy for cerebral adrenoleukodystrophy, and 19 patients have started on betibeglogene autotemcel (beti-cel, Zynteglo), its marketed gene therapy for transfusion dependent thalassemia (TDT). As such, bluebird bio has reported 23 total cell collections for SCD/TDT gene therapies lovo-cel and beti-cel. The company expects that patient uptake of the 3 aforementioned therapies will continue to increase, with 85 patient starts expected across the therapies by the end of the year.

“We are seeing clear evidence that our commercial launch is accelerating, with over 20 cell collections completed in SCD and TDT to date in 2024, and more than 40 additional patients already scheduled to initiate the treatment journey for a bluebird gene therapy by the end of this year,” Andrew Obenshain, MBA, the chief executive officer of bluebird bio, said in a statement.

 “We are further encouraged by the commitment to provide patient access across both commercial and government payers, most recently conveyed through multiple positive Medicaid decisions and the growing number of published coverage policies for Lyfgenia, and we expect approximately 85 patient starts across our portfolio this year.”

Notably, unlike lovo-cel, exa-cel is indicated for both SCD and TDT. Since Vertex has not clarified the breakdown of patients treated with exa-cel for each disease, direct comparison is difficult. The approval in TDT came slightly later, with 

“Vertex delivered another strong quarter of revenue growth coupled with outstanding execution across the business, and we are increasing our full year product revenue guidance,” Reshma Kewalramani, MD, the chief executive officer and president of Vertex, said in an August 1, 2024, statement.

 “Our focus for the second half of the year remains on commercial execution in cystic fibrosis and the global launch of Casgevy, readying for the upcoming potential launches of the vanzacaftor triple in cystic fibrosis and suzetrigine in acute pain, while rapidly advancing a robust pipeline that is poised to deliver value for patients and shareholders for the long term.”

Beyond gene therapy for SCD and TDT, uptake of 

hemophilia gene therapies has also been slow

. Although BioMarin’s valoctocogene roxaparvovec (val-rox, marketed as Roctavian) was approved in June 2023, the first patient outside of clinical trials 

 until December 2023, at the Center for Inherited Bleeding Disorders (CIBD) in California.

 Just this month, BioMarin announced that 

 with regard to val-rox, with the company now mainly focusing on distributing the gene therapy in the United States, Germany, and Italy, the 3 countries in which it has been approved for use by relevant regulatory authorities and is reimbursed.

 UniQure and CSL Behring’s hemophilia B gene therapy, etranacogene dezaparvovec (marketed as Hemgenix), which was 

, has also been slow to be embraced by patients.

“We haven't seen a lot of patients dosed yet,” Steven W. Pipe, MD, a professor of pediatric hematology/oncology at CS Mott Children’s Hospital, told 

 regarding Hemegenix earlier in 2024. “And I don't think that’s related to either the enthusiasm of the clinicians or the patients, but really just the mechanics of how to deliver this in the clinical space, as opposed to the research trials... We've seen that a lot of the hemophilia treatment center sites have got their components together, their infrastructure and personnel so that they can actually start delivering this in the commercial setting. And so, I'm really looking forward to seeing this making a difference in patients' lives in a real world setting.”

REFERENCES
1. bluebird bio reports second quarter 2024 results and highlights operational progress and 2024 guidance. News release. bluebird bio, Inc. August 14, 2024. Accessed August 15, 2024. https://investor.bluebirdbio.com/news-releases/news-release-details/bluebird-bio-reports-second-quarter-2024-results-and-highlights
2. Stock dive for bluebird as sickle cell gene therapy lags behind Vertex rival. News article. Anna Bratulic. FirstWord Pharma. August 14, 2024. Accessed August 15, 2024. https://firstwordpharma.com/story/5885598
3. Vertex announces US FDA approval of CASGEVY™ (exagamglogene autotemcel) for the Treatment of Transfusion-Dependent Beta Thalassemia. News release. Vertex Pharmaceuticals Incorporated. January 16, 2024. Accessed August 15, 2024. https://news.vrtx.com/news-releases/news-release-details/vertex-announces-us-fda-approval-casgevytm-exagamglogene
4. Vertex reports second quarter 2024 financial results. News release. Vertex Pharmaceuticals Incorporated. August 1, 2024. Accessed August 15, 2024. https://investors.vrtx.com/news-releases/news-release-details/vertex-reports-second-quarter-2024-financial-results
5. Center for Inherited Blood Disorders Administers Country's First Gene Therapy Infusion to Treat Hemophilia A. News release. Center for Inherited Blood Disorders. January 11, 2024. Accessed August 15, 2024. https://firstwordpharma.com/story/5817834?from=article
6. BioMarin Announces Updated Strategy for ROCTAVIAN® to Focus on U.S., Germany and Ital. News release. BioMarin Pharmaceutical Inc. August 5, 2024. Accessed August 15, 2024. https://investors.biomarin.com/news/news-details/2024/BioMarin-Announces-Updated-Strategy-for-ROCTAVIAN-to-Focus-on-U.S.-Germany-and-Italy/default.aspx
7. FDA approves first gene therapy to treat adults with hemophilia B. News release. FDA. November 22, 2022. Accessed August 15, 2024. https://www.fda.gov/news-events/press-announcements/fda-approves-first-gene-therapy-treat-adults-hemophilia-b

bluebird bio has reported 23 total cell collections for SCD and TDT gene therapies lovo-cel and beti-cel and Vertex Pharmaceuticals has reported approximately 20 cell collections for SCD/TDT gene therapy exa-cel.

Topic

Uptake of Nononcology Gene Therapy Remains Slow in Hematology

(arsa-cel, OTL-200; Orchard Therapeutics) is a gene-edited cell therapy designed to restore arylsulfatase A (ARSA) enzyme activity in children with presymptomatic (PS) late infantile (LI), PS early juvenile (EJ), or early symptomatic (ES) early juvenile (EJ) metachromatic leukodystrophy (MLD).

 arsa-cel under the name Lenmeldy to become the first gene therapy for children with MLD to be approved in the United States, following its approval in the European Union, UK, Iceland, Switzerland, Liechtenstein and Norway under the name Libmeldy.1 Orchard Therapeutics previously announced that the FDA had accepted the biologics license application with 

The FDA’s decision was based on data from patients treated with arsa-cel across 2 clinical trials (NCT01560182; NCT03392987) and additional patients treated in expanded access frameworks. These patients had follow-up times ranging from 0.64 years to 12.19 years (median, 6.76).

“Metachromatic leukodystrophy, is a really important unmet need in the pediatric community. So, this is a disease that's rare, it affects about one in 40,000 children. And up until recently, we have had no curative treatment option for this,” Madeleine Powys, MBBS, Staff Specialist, Blood Transplant and Cell Therapies, The Children's Hospital at Westmead, told 

. "Autologous hematopoietic stem cell gene therapy has offered really promising new hope for these patients.”

Madeleine Powys, MBBS, on Lessons Learned With Libmeldy

Arsa-cel is currently being evaluated in 6 participants enrolled in a phase 3 clinical trial (NCT04283227). The trial enrolled participants with documented biochemical and molecular diagnosis of MLD, including low ARSA activity and identification of 2 disease-causing ARSA alleles, with novel mutations analyzed and excluded as common polymorphisms, alongside specific genotype criteria. Symptomatic individuals must have onset between 7 and 17 years of age, or pre-symptomatic participants must be less than 17 years at treatment initiation and have a sibling with late-juvenile MLD variant, along with normal cognitive and motor function, with seizures or disease signs revealed by instrumental evaluations not being exclusionary if present alone, and compliance with contraceptive use requirements if applicable, with signed informed consent or assent provided by the participant or guardian.

The exclusion criteria for the study include documented HIV infection, malignant neoplasia except localized skin cancer or hereditary cancer syndrome unless successfully treated with no recurrence, myelodysplasia, acute myeloid leukemia, or serious hematological disorders, current enrollment in other interventional trials, prior allogeneic HSPC gene therapy or gene therapy, symptomatic herpes zoster unresponsive to treatment, active tuberculosis unless on antibiotic prophylaxis, acute or chronic stable Hepatitis B or positive Hepatitis C RNA test result unless specific conditions are met, end-organ dysfunction, severe infection not responsive to treatment, or other severe diseases deemed inappropriate for the study by the investigator. Additionally, testing for other transmissible infectious agents may be considered, and participants with elevated liver enzymes or bilirubin may be included after discussion and agreement with the medical monitor.

The study’s primary measures involve assessing the OTpbmsL-200 Arylsulfatase A (ARSA) activity levels in cerebrospinal fluid (CSF) and the neuronal metabolite ratio of N-acetyl-aspartate (NAA) to creatine (Cr) in white matter brain regions, both evaluated at 24 months post-treatment, with changes from baseline being monitored.

Secondary measures involve evaluating changes in ARSA activity levels in CSF and neuronal metabolite ratio in white matter brain regions, assessing ARSA levels in peripheral blood mononuclear cells (PBMCs) and specific subtypes, comparing neuronal metabolite ratios to baseline, siblings, or untreated controls, determining engraftment through lentiviral positivity in bone marrow progenitors and vector copy number in BM cells and PBMCs, assessing severity scale for brain MRI, neurocognitive function, full neurological clinical examination, gross motor function classification, nerve conduction velocity, Vineland Adaptive Behavior Scale, and monitoring conditioning regimen and non-conditioning-related adverse events up to 8 years post gene therapy, along with hematological reconstitution, infusion-related reactions, immune response, abnormal clonal proliferation, replication-competent lentivirus, and integration site analysis findings over time.

, held February 4-9, in San Diego, California, by Vera Gallo, MD, staff pediatrician, San Raffaele Telethon Institute for Gene Therapy. The data were from 5 patients with LJ MLD that had follow-up ranging from 3.2 to 21.3 months (median, 17.3). At the time of treatment, 3 patients had PS MLD and 2 had ES MLD. The group included a 2.7-year-old girl (PS), a 9.9-year-old boy (ES), a 15.2-year-old boy (PS), a 6.6-year-old girl (PS), and 10.9-year-old boy (ES) as of the December 2023 cutoff date.

"This represents of course, the proof of principle that gene therapy with ex- vivo lentiviral gene therapy into stem cells can correct a lysosomal storage disorder (LSD)... and could be applicable to other LSDS. So we're working on new diseases to bring this approach of enzyme correction also to other LSDs," investigator Alessandro Aiuti, MD, PhD, deputy director, clinical research, and head, Clinical Research Unit, San Raffaele Telethon Institute for gene therapy, and Group leader, Pathogenesis and therapy, primary immunodeficiencies unit, and full professor, Università Vita Salute San Raffaele, and chief of clinic, Pediatric Immunohematology Unit, San Raffaele, told 

Data from these participants showed that they all had normal hematological reconstitution and engraftment that was consistent with arsa-cel outcomes seen in patients with early-onset MLD who have been treated in other settings. Time to neutrophil engraftment ranged from 26 to 42 days (median, 33) posttreatment and time to platelet engraftment ranged from 25 to 46 days (median, 26) posttreatment. ARSA activity reached supranormal levels in the PBMCs and in CD15+ cells and increased to normal levels in the CSF in 3 patients for whom central nervous system pharmacodynamic efficacy measures were available.At 90 days after administration of arsa-cel transduced bone marrow progenitors made up between 23.81% to 81.25% of bone marrow progenitors. At this time point, the PBMCs showed a median vector copy number (VCN) of 0.49 copies/cell and the CD15+ cells showed a median VCN of 0.82 copies/cell.

In terms of safety, there were no serious adverse events (SAEs) deemed potentially related to arsa-cel. One nonserious AE deemed potentially related to the therapy, a case of erythematous rash, occurred in 1 patient. No SAEs deemed potentially related to the Busulfan conditioning regimen occurred; although cases of febrile neutropenia, cytopenia, and stomatitis were deemed to have potential relation to the regimen. An SAE of upper respiratory tract infection occurred in 1 patient. One patient with prolonged thrombocytopenia who had previously experienced treatment-failure with allogeneic transplant in the form of autologous reconstitution was administered thrombopoietin receptor agonist therapy for 5 months. No multilineage engraftment of transduced cells or malignancy occurred and there was no indication of clonal expansion or replication competent lentivirus.

1. FDA Approves First Gene Therapy for Children with Metachromatic Leukodystrophy. News release. Orchard Therapeutics. March 18, 2024. Accessed March 18, 2024. https://www.fda.gov/news-events/press-announcements/fda-approves-first-gene-therapy-children-metachromatic-leukodystroph
2. Orchard Therapeutics announces acceptance of biologics license application for OTL-200 in MLD and receives priority review. News release. Orchard Therapeutics. September 18, 2023. Accessed September 18, 2023. https://ir.orchard-tx.com/news-releases/news-release-details/orchard-therapeutics-announces-acceptance-biologics-license
3. Fumagalli F, Calbi V, De Mattia F, et al. Long-term clinical outcomes of atidarsageneautotemcel (autologous hematopoietic stem cell gene therapy) preserves cognitive and motor development in early-onset metachromatic leukodystrophy with up to 12 years follow-up. Presented at: WORLDSymposium, held February 4-9, in San Diego, California. Poster #92
4. Gallo V, Calbi V, De Mattia F, et al. Lentiviral hematopoietic stem cell gene therapy (atidarsageneautotemcel) for late juvenile metachromatic leukodystrophy (MLD). Presented at: WORLDSymposium, held February 4-9, in San Diego, California. Poster #96

The gene-edited cell therapy has been approved as Lenmeldy by the FDA. 

Phase 3 Trial Seeks to Continue Supporting Arsa-Cel Gene Therapy for MLD 

The FDA is no longer requiring Risk Evaluation and Mitigation Strategies (REMS) for the 6 CD19/BCMA-directed chimeric antigen receptor T-cell (CAR-T) therapies that are approved by the agency.

The 6 products include Bristol Myers Squibb (BMS) and 2seventybio’s idecabtagene vicleucel (ide-cel; marketed as Abecma); BMS’s lisocabtagene maraleucel (liso-cel; marketed as Breyanzi); Janssen and Legend Biotech’s ciltacabtagene autoleucel (cilta-cel; marketed as Carvykti); Novartis’s tisagenlecleucel (tisa-cel; marketed as Kymriah); Kite Pharma’s brexucabtagene autoleucel (brexu-cel; marketed as Tecartus); and Kite Pharma’s axicabtagene ciloleucel (axi-cel; marketed as Yescarta). The FDA made the move with the view that the REMS are no longer necessary to ensure a favorable risk-benefit-ratio for the products and that dropping the requirement may increase accessibility to these therapies.

“The FDA has taken the bold step to remove the REMS requirement from giving CAR-T therapies,” Vinay Prasad, MD, MPH, the chief medical and scientific officer and the director of the Center for Biologics Evaluation and Research at the FDA, said in a statement.

 “REMS is a useful safety system, but reevaluation over time helps inform whether a REMS is still needed to ensure that the benefits of a product outweigh its risks. Eliminating the REMS that is no longer needed also expedites the delivery of potentially curative treatments to patients and reduces burden on providers.”

With the removal of the REMS requirement, hospitals and clinics that provide these therapies no longer necessitate a specific certification. Additionally, these centers are no longer required to have on-site tocilizumab immediately accessible.

“Physicians and institutions now have greater experience identifying and managing toxicities with the currently approved CAR-T products,” Richard Pazdur, MD, the FDA Oncology Center of Excellence director, added to the statement.

 “This approach will potentially facilitate patient access to these treatments while continuing to prioritize safety.”

Safety monitoring for the affected products will continue in the form of adverse event reporting according to established protocols. The existing requirements for postmarketing observational safety studies assessing secondary malignancy risks and long-term safety follow-up also remain in place.

Alongside removal of the REMS requirement, the FDA also made changes to the labels for liso-cel and ide-cel.

 Notably, BMS released a statement celebrating the FDA’s decision, pointing out that logistical and geographic barriers have likely hindered some patients ability to receive CAR-T that the FDA’s changes to the labels for liso-cel and ide-cel should make the products more accessible. The company noted that historically only about 2 in 10 eligible patients are treated with CAR-T products. BMS highlighted that the FDA’s labeling change reduces the requirement for patients to be located near a healthcare facility for 4 weeks posttreatment down to 2 weeks after treatment with BMS’s CAR-T products.

"Living with blood cancer is challenging, but patients and their loved ones still need to maintain jobs, take care of families, and plan for the future,” Sally Werner, the chief executive officer of Cancer Support Community, said in the BMS press release.

 “Today’s announcement reduces some of the most onerous requirements that may have previously discouraged patients, particularly those who live far from a treatment center, from seeking the potentially transformational effects of cell therapy. We applaud any and all efforts to continue to break down barriers, reducetime burden on patients and caregivers, and increase uptake of this life-saving therapy."

REFERENCES
1. FDA eliminates risk evaluation and mitigation strategies (REMS) for autologous chimeric antigen receptor CAR T cell immunotherapies. News release. FDA. June 27, 2025. July 3, 2025. https://www.fda.gov/news-events/press-announcements/fda-eliminates-risk-evaluation-and-mitigation-strategies-rems-autologous-chimeric-antigen-receptor
2. U.S. Food and drug administration approves streamlined patient monitoring requirements and removal of REMS programs within Bristol Myers Squibb’s cell therapy labels. News release. Bristol Myers Squibb. June 26, 2025. Accessed July 3, 2025. https://news.bms.com/news/corporate-financial/2025/U-S--Food-and-Drug-Administration-Approves-Streamlined-Patient-Monitoring-Requirements-and-Removal-of-REMS-Programs-within-Bristol-Myers-Squibbs-Cell-Therapy-Labels/default.aspx

The FDA made the move with the view that the REMS are no longer necessary to ensure a favorable risk-benefit-ratio for the products and that dropping the requirement may increase accessibility to these therapies.

FDA Drops REMS Requirement for 6 Approved CAR T-Cell Therapies

This article originally appeared on our sister site, 

In a retrospective, observational study, patients with diffuse large B-cell lymphoma (DLBCL) who were treated with tisagenlecleucel (tisa-cel; Kymriah), axicabtagene ciloleucel (axi-cel; Yescarta), or lisocabtagene maraleucel (liso-cel; Breyanzi) across their FDA-approved indications did not show statistically significant differences in overall survival (OS) (log-rank test: χ², 0.773; degrees of freedom [df], 1; 

 The data were presented in a poster at t

he European Hematology Association (EHA) 2025 Congress

, held June 12 to 15, both virtually and in Milan, Italy.

Respective hazard ratios for axi-cel and tisa-cel, axi-cel and liso-cel, and tisa-cel and liso-cel cohorts constituted .903 (95% CI, 0.719-1.134), 1.065 (95% CI, 0.831-1.364), and 1.163 (95% CI, 0.856-1.582).

“This large-scale, real-world study provides valuable insights into mortality rates associated with 3 approved CAR T-cell therapies for refractory lymphomas over a 3-year period," presenting study author Vladimir Otasevic, MD, PhD, an internal medicine specialist and associate medical director of Hematology at Parexel, and colleagues wrote in the poster. "While mortality rates varied among therapies at different time points, survival analysis of [patients with] DLBCL revealed no statistically significant differences in OS outcomes."

Tisa-cel, axi-cel, and liso-cel are currently the only FDA-approved CAR-T products available for refractory DLBCL.

 In refractory lymphomas, the modality has become a standard of care. Although, insufficient real-world data regarding the performance of these 3 products in the routine clinical setting is available. This study thus aimed to evaluate survival rates following real-world CAR-T treatment by utilizing a large electronic health records database.

Investigators used the TriNet global dataset, which houses the electronic health records of 228,062,680 patients. Data were pooled from patients with DLBCL who had received tisa-cel (n = 1140), axi-cel (n = 1850), or liso-cel (n = 440) across all indications over a 3-year period postinfusion to determine whether there are statistically significant differences in OS between the 3 products.

All-cause mortality was evaluated at months 1, 3, 6, 12, and 36 after infusion. Kaplan-Meier survival analysis was performed to estimate survival outcomes in patients with DLBCL across the 3 therapies during the 3-year post treatment period. Data cutoff was February 19, 2025.

Additional data indicated that the cumulative all-cause mortality rates 1, 3, 6, 12, and 36 months after CAR T-cell therapy infusion with tisa-cel were 2.6%, 7.0%, 12.3%, 17.5%, and 23.7%, respectively. With axi-cel, these respective rates were 2.2%, 7.6%, 13.5%, 19.5%, and 24.5%. Respective rates with liso-cel were 2.3%, 4.5%, 11.4%, 15.9%, and 18.2%.

“These findings indicate consistent survival outcomes in real-world settings as observed in pivotal clinical trials," Otasevic and colleagues concluded.

 "Future research should focus on identifying predictors of mortality and strategies to mitigate risks while maintaining therapeutic efficacy across different CAR T products."

Click here to view more coverage of EHA's 2025 Congress.

REFERENCES
1. Maiti K, Otasevic V, Lunney N, D’Angelo K, Learn C, et al. Three-year real-world mortality analysis of CAR-T therapies: tisa-cel, axi-cel, and liso-cel. Presented at: 2025 European Hematology Association Congress; June 12-15, 2025; Milan, Italy. Abstract PS1930.
2. Approved cellular and gene therapy products. FDA. Updated May 15, 2025. Accessed June 17, 2025. https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/approved-cellular-and-gene-therapy-products

The 3 FDA-approved CAR T-cell therapies showed comparable survival outcomes in DLBCL over a 3-year period.

Canonical

Survival Outcomes Found to Be Comparable for Axi-Cel, Liso-Cel, and Tisa-Cel in Real-World DLBCL Data

Seattle Children’s Research Institute is currently conducating preclinical research on the potential use of BCMA-directed dimerizing agent-regulated immune-receptor complex (DARIC) T-cells for the clearance of plasma cells, which could have applications in autoimmune disease. Peter Cook, PhD, a senior research scientist at Seattle Children’s Research Institute, presented early findings related to this goal at 

the American Society of Gene & Cell Therapy (ASGCT) 28th Annual Meeting

, held May 13 to 17, 2024, in New Orleans, LA. 

 interviewed Cook to learn more. He explained the rationale behind the use of the DARIC cells, discussed the key findings he presented, and touched on next steps for the research.

 Can you give some background context about your presentation at ASGCT?

 We presented on work that we published earlier this year on developing a cell-based therapy specifically to target antibody-secreting plasma cells. It's a BCMA CAR T-cell that's actually drug inducible. The CAR T-cell won't work unless the patient is simultaneously delivered a small molecule drug, rapamycin, and the cells can be turned off by withdrawal of that drug.

What were the key findings that you presented?

We demonstrated our ability to produce these inducible BCMA CAR T-cells, which we call DARIC CAR T-cells. DARIC is an abbreviation for the drug-inducible CAR construct. We showed that by lentiviral transduction we can make cells that have equivalent activity to cells that express a traditional BCMA CAR, except that their activity is solely dependent on the presence of the dimerizer, which causes the CAR to come together. We showed that in vitro targeting multiple myeloma cancer cell lines, which express BCMA, and then also in vivo in mice that have multiple myeloma tumor cells, the tumor is cleared by the DARIC CAR T-cells only if the mice are simultaneously dosed with the drug. 

Then what we were really interested in is whether we could use these cells to target normal plasma cells, which secrete antibodies. In some cases those antibodies can be bad actors, for example in solid organ transplantation if a patient has preexisting antibodies that cause organ rejection. We showed that in vitro with a plasma cell differentiation system that we had developed, these DARIC CAR T-cells could specifically kill only differentiated plasma cells and not undifferentiated B-cells, again, in the presence of the drug. Then, if we took those plasma cells and implanted them into mice, where they'll engraft and secrete human IgG, if those mice were then dosed with the DARIC cells, we saw a complete drop of human IgM and IgG titers in those mice.

How would you summarize the big picture implications you would want the broader healthcare community to take away from this?

I think we're in kind of the early days of using cell-based therapy for autoimmune disease to target antibody response that drives disease. There's already been tremendous excitement about using CD19 CAR T-cells, and there's been, in a very small number of patients, tremendous efficacy in lupus in that model. But as more people get involved, and we start expanding this therapy out to other disease indications, there will be cases where CD19 targeting isn't really what we want, and what we really want is something that's more specific to the plasma cells, which don't actually express CD19. The example I cited earlier of antibody rejection of solid organ transplants is one example. So we see that the BCMA DARIC cells could be a useful tool in the cell toolbox for use in autoimmune disease targeting antibodies that are acting as bad actors in that setting. In addition, the drug-inducible context can be useful specifically if you want to time things to the flare and remission cycle of autoimmune disease.

Are there any challenges that came up in this research that still need to be addressed?

I mean, the most obvious challenge for all of these cell-based therapies is probably cost of goods and complexity of the therapy. One thing that we're interested in is in vivo conversion of cells. For example, you could imagine a lentiviral construct that's been pseudotyped to target CD3 T-cells that would then deliver the BCMA DARIC. Then, instead of doing all of this complicated ex vivo engineering of the patient's cells and then redosing along with cytotoxic chemotherapy to improve engraftment, you would simply give the patient a dose of this lentiviral therapy package, which would then spontaneously convert their cells. Those cells with the DARIC construct would be nonfunctional unless you also gave the small molecule drug to turn them on, which could be an additional safety feature. That's sort of a challenge for the field, but I think there's a lot of interesting efforts to develop the technology to address that.

Are there any like future plans or next steps for this that you could discuss a little bit?

The strategy that I just described for developing an in vivo delivery system is certainly one next step. In our paper that we published, we didn't really use any disease models or organ transplant (you could imagine a skin graft model). We just showed that these cells can clear human plasma cells in engrafted mice. So moving it into actual relevant disease models, I think, would also be a clear next step for preclinical testing of this system.

Is there anything else you want to share?

I'll take a chance to plug the Center for Immunity and Immunotherapies at Seattle Children's Research Institute, where we have a tremendous and growing collection of investigators who are focused on developing therapies for autoimmune disease, many of them based on cell engineering around T-cells and B-cells and hematopoietic cells. I think it is just doing tremendous work in this field.

This transcript has been edited for clarity.

Click here to view more coverage of the 2025 ASGCT Annual Meeting.

REFERENCE
1. Cook P. Targeting human plasma cells using small molecule regulated BCMA CAR T cells eliminates circulating antibodies in humanized mice. Presented at: at ASGCT 28th Annual Meeting, held May 13 to 17, 2024, in New Orleans, LA. Abstract #1258

Peter Cook, PhD, a senior research scientist at Seattle Children’s Research Institute, discussed preclinical work on using dimerizing agent-regulated immune-receptor complex T-cells to target plasma cells.




Exploring DARIC CAR T Cells for Autoimmune Indications

According to the World Ovarian Cancer Coalition, at a global scale ovarian cancer is the 8th most common cancer for women and the 8th most common cause of death from cancer for women. Each year around the world, approximately 207,000 women with ovarian cancer die. Although treatment options exist, substantial unmet need remains, and many companies and academic institutions are currently pursuing new treatment approaches for the disease.

An important area of interest for new therapeutic development in ovarian cancer is cell therapy, such as chimeric antigen receptor T-cell (CAR-T) therapy and T-cell receptor-engineered T-cell (TCR-T) therapy. In honor of World Ovarian Cancer Day, observed annually on May 8 by the patient and clinician communities, 

® is taking a look back at the progress that was made for cell therapy in ovarian cancer over the past year. Click the "READ MORE" buttons for more details and information about each item.

Gradalis' Personalized Immunotherapy Gemogenovatucel-T Receives FDA RMAT Designation

 — Gradalis' Gemogenovatucel-T (also known as Vigil), an investigational personalized cellular immunotherapy currently being evaluated for the treatment of ovarian cancer, has received regenerative medicine advanced therapy (RMAT) designation from the FDA.

The product is being evaluated in the ongoing randomized, placebo-controlled phase 2b VITAL clinical trial (NCT02346747) in patients with newly diagnosed, advanced stage IIIb/IV ovarian cancer who are homologous recombination proficient (HRP), have a high clonal tumor mutation burden (cTMB-H), and who remain in complete response after debulking surgery and frontline platinum-based doublet chemotherapy. According to the clinicaltrials.gov page, which was most recently updated on January 9, 2025, VITAL is active, but no longer recruiting new patients. It was initiated in February 2015 and has an estimated completion date of December 2025. The total enrollment for the study is listed as 92 patients. According to Gradalis, results from the study showing a statistically significant and clinically meaningful improvement in overall survival (OS) in patients with HRP ovarian cancer and cTMB-H informed the FDA's decision to grant the RMAT designation, which applies specifically to that indication.

“The RMAT designation for Vigil highlights the transformative capacity of our unique immunotherapy to benefit women battling advanced ovarian cancer,” David Shanahan, BS, the chief executive officer of Gradalis, said in a statement. “This important recognition affirms that Vigil has the potential to extend patient survival and may offer a safer, more precise therapeutic approach to a population in urgent need of innovative solutions. We continue to advance our Vigil development efforts as we work to bring this investigational therapy to patients as rapidly as possible.”

Anixa Biosciences Seeks Protocol Change to Enable Repeat Dosing in Trial for Ovarian Cancer CER-T

 — Anixa Biosciences and its partner Moffitt Cancer Center have submitted a protocol amendment to the FDA for their ongoing phase 1 clinical trial (NCT05316129) evaluating Anixa's novel follicle stimulating hormone receptor (FSHR)-targeting chimeric endocrine receptor (CER) T-cell therapy for the treatment of ovarian cancer, aimed at enabling the use of second doses for patients who may benefit.

 of a single-patient investigational new drug (IND) application to redose a patient in the trial whose tumor showed cellular infiltration and necrosis in a biopsy, suggesting the CER-T therapy had produced biologic activity. In order to avoid the need to continuously submit single-patient IND applications on a case-by-case basis, the company’s protocol amendment will allow for patients in the trial to receive a second leukapheresis and dose of the CER-T, without the need for additional clearance.

"In initial phase 1 clinical trials, it is customary to begin with low, often subtherapeutic cell doses to verify safety, before increasing the dose levels,” principal investigator Robert Wenham, MD, MS, FACOG, FACS, the chair of the Gynecologic Oncology Department at Moffitt, said in a statement. “In our study, the patient approved for a second dose by the individual IND received the starting, lowest dose. While initially meeting the criteria for progression due to size of her predominate tumor, her cancer has since remained relatively stable and she has not received additional therapy since her first infusion. We are hoping a second, higher dose may improve her overall response and outcome. In general, we anticipate that higher cell doses will lead to efficacy, but for solid tumors, a second dose may be needed in a subset of patients to improve the rate and durability of responses."

First Patient Receives TCR-T Therapy in Multiplexed Study Screening Patients With Melanoma, Cervical Cancer and More

 — Screening is underway for participants with solid tumors to receive T-Plex, a multiplexed TCR-T therapy, with 1 participant having received 1 Singleplex therapy so far in a phase 1 study (NCT05973487) with no acute toxicities.

Data from the TSCAN-003 screening study (NCT05812027) and initial data from the phase 1 study were presented at the 

2024 American Society of Clinical Oncology (ASCO) Annual Meeting

, held May 31 - June 4, in Chicago, Illinois, by Dawn Pinchasik, MD, MS, vice president, clinical development, TScan Therapeutics.

The TSCAN-003 screening study has enrolled over 300 participants since September 2023. Over 75% of participants have melanoma, head and neck cancer, non-small lung cancer, or ovarian cancer. Cervical, uterine, anogenital, and soft tissue sarcoma cancers are also represented. The study screens patients for a match to one of the 4 TCR-Ts in the ImmunoBank. Of the enrolled participants so far, 71% had at least one HLA match in the ImmunoBank, and of these, 68 have passed the screening for target expression and LOH. Of the 68, 73% have at least 1 TCR-T match and 27% have more than 1 TCR-T match, qualifying for T-Plex therapy.

A2 Bio’s Trial for Solid Tumor Tmod CAR-T A2B694 Doses First Patient

 — Triumvira Immunologics’ TAC01-CLDN18.2, an investigational autologous T-cell antigen coupler (TAC) CLDN18.2-targeted T-cell product, is set to be evaluated in the first-in-human phase 1/2 TACTIC-3 (NCT05862324) clinical trial for patients with various types of solid tumors. Triumvira recently presented a poster detailing the design of the dose escalation and dose expansion clinical trial at the 2024 American Society of Clinical Oncology (ASCO) Genitourinary Cancers (GI) Symposium, held January 18-20, in San Francisco, California.

TAC01-CLDN18.2 integrates TAC, Triumvira’s proprietary chimeric receptor that is intended to activate and direct T-cells against tumor cells. TAC01-CLDN18.2 specifically expresses the CLDN18.2 TAC with the intention of targeting tumor cells that are 

. The TACTIC-3 trial is currently recruiting patients with gastric cancer, gastroesophageal cancer (GEJ), esophageal adenocarcinoma (AC), non–small cell lung cancer (NSCLC), cholangiocarcinoma, pancreatic ductal AC (PDAC), ovarian mucinous cancer, and colorectal cancer.

The phase 1 dose escalation portion of the study will follow a standard 3+3 design and aims to treat 9 to 24 patients in total. Four different dose levels will be evaluated: 1-3x10

 cells/kg. Patients with gastric cancer, GEJ, esophageal AC, NSCLC, PDAC, cholangiocarcinoma, ovarian mucinous cancer, and colorectal cancer are eligible for this portion of the trial. These participants must have cancer that is negative for expression of HER2 and must have had at least 2 lines of prior therapy.

REFERENCE
1. Ovarian cancer key stats. World Ovarian Cancer Coalition. Website. Accessed May 8, 2025. https://worldovariancancercoalition.org/about-ovarian-cancer/key-stats/

In observance of World Ovarian Cancer Day, held annually on May 8, we took a look back at news in cell therapy for ovarian cancer indications.

Eunice Wang, MD

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