Using CAR T-Cell Therapy Earlier May Produce More Benefit in ALL

Bijal Shah, MD, MS, an associate member in the Department of Malignant Hematology at Moffitt Cancer Center, discusses the timing of treatment with chimeric antigen receptor (CAR) T-cell therapy in regard to the data from the ZUMA-3 trial (NCT02614066) of brexucabtagne autoleucel (Tecartus) in patients with acute lymphoblastic leukemia (ALL).

Shah feels that what the data reinforce for him and for patients is that CAR T-cell therapy needs to be integrated earlier in the disease course, and the takeaway from these findings is to use this treatment before patients are critically ill. Patients with ALL have less of a buffer than patients with large B-cell lymphoma, who can get through therapy because it is less toxic, and the aggressive lymphomas do not always go into a leukemic phase that takes over the bone marrow space and limits the ability to develop meaningful immune response against infections.

Patients with ALL experience these issues and are usually heavily pretreated and have a history of fungal pneumonias and other hard-to-treat atypical infections before receiving CAR T-cell therapy. Investigators need to find a way to treat with CAR T before patients get to that point, according to Shah. If it isn’t used earlier in this setting, then 15% to 20% of patients with ALL will be excluded from receiving a promising therapy because they are too ill.