Bijal Shah, MD, MS

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

Shah hopes that he and his fellow investigators have done enough to show the FDA that this treatment is safe option to treat patients with ALL. Patients in the ZUMA-3 trial had a 71% complete remission (CR) rate with CAR T-cell therapy, which Shah says is unheard of in this population. These patients had progressed on previous therapies or after transplant. Patients achieved deep remissions and most had minimal residual disease negativity after treatment. These were real remissions, as opposed to cosmetic remissions, according to Shah.

This efficacy translated into pronounced benefits in relapse-free survival, duration of remission, and overall survival. Patients who achieved CR did not reach a median overall survival with CAR T. Shah feels that this is incredible for this patient population. CAR T-cell therapy was expected to be a meaningful treatment in ALL, and now the data show it can be used safely.

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Bijal Shah, MD, MS, discusses the results of treatment with the chimeric antigen receptor T-cell therapy brexucabtagne autoleucel in the ZUMA-3 trial in patients with acute lymphoblastic leukemia.

ZUMA-3 Trial of CAR T Results in Impressive Efficacy for Patients With 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.

Bijal Shah, MD, MS, discusses the timing of treatment with chimeric antigen receptor T-cell therapy in regard to the data from the ZUMA-3 trial of brexucabtagne autoleucel in patients with acute lymphoblastic leukemia.

Bijal Shah, MD, MS | Authors

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ZUMA-3 Trial of CAR T Results in Impressive Efficacy for Patients With ALL

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