Michael Wang, MD, on Liso-Cel's Approval in Mantle Cell Lymphoma

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The professor in the Department of Lymphoma/Myeloma at MD Anderson Cancer Center discussed the advantages the newly approved CAR-T has for older, frailer patients.

“It will be a very important part of our treatment paradigm.”

Patients with mantle cell lymphoma (MCL), an incurable form of nonHodgkin lymphoma, can often achieve an initial response to treatments, but later experience disease relapse. Patients often go through a series of trying different treatments, experiencing some level of response, and later experiencing disease relapse, until the disease ultimately becomes refractory to all approved treatments. Among the current treatment options for relapsed/refractory (r/r) MCL is brexucabtagene autoleucel (brexu-cel), an autologous CD19-directed chimeric antigen receptor T-cell (CAR-T) therapy marketed as Tecartus by Kite that was approved for r/r MCL by the FDA in 2020.1 Although brexu-cel provides robust overall response rates and complete response (CR) rates, it carries a substantial risk of high grade cases of cytokine release syndrome (CRS) and neurotoxicity. As such, brexu-cel may be a suitable choice for younger patients with MCL, but is difficult to tolerate for older, frailer patients.

Recently, on May 30, 2024, the FDA approved Bristol Myers Squibb’s lisocabtagene maraleucel (liso-cel, marketed as Breyanzi), another autologous CD19-directed CAR-T therapy, for the treatment of adults with r/r MCL who have been previously treated with at least 2 lines of systemic therapy, including a Bruton tyrosine kinase inhibitor.2 Following the FDA’s decision, CGTLive® spoke with Michael Wang, MD, a professor in the Department of Lymphoma/Myeloma at MD Anderson Cancer Center, who served as lead investigator on the phase 1 TRANSCEND NHL 001 clinical trial (NCT02631044) that led to liso-cel's approval in r/r MCL. In the interview, Wang expressed enthusiasm regarding the approval and emphasized that liso-cel boasts lower rates of high grade CRS and neurotoxicity compared to brexu-cel, but retains a comparable CR rate. As such, he highlighted that it should provide an important new option for older and frailer patients with r/r MCL. He also spoke about areas of interest for further research regarding liso-cel in MCL.

REFERENCES
1. FDA approves brexucabtagene autoleucel for relapsed or refractory mantle cell lymphoma. News release. FDA. July 24, 2020. Accessed June 6, 2024. https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-brexucabtagene-autoleucel-relapsed-or-refractory-mantle-cell-lymphoma
2. U.S. Food and Drug Administration Approves Bristol Myers Squibb’s Breyanzi as a New CAR T Cell Therapy for Relapsed or Refractory Mantle Cell Lymphoma. News release. FDA. May 30, 2024. Accessed June 6, 2024. https://www.fda.gov/drugs/resources-information-approved-drugs/fda-grants-accelerated-approval-lisocabtagene-maraleucel-follicular-lymphoma

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