Tecartus, a CAR T-cell immunotherapy, can now treat acute lymphoblastic leukemia

Acute lymphoblastic leukemia (ALL) is a blood and bone marrow cancer occurring due to the abnormal proliferation of immature lymphocytes in the bone marrow. These lymphocytes are mutated and, therefore, cannot function as normal cells. It could become metastatic and invade other organs: the central nervous system, liver, spleen, blood, and lymph nodes. In children, ALL is one of the significant types of cancer. It is also seen in adults and is male-dominated.

The current treatment guideline includes

1. Chemotherapy
2. Radiation therapy
3. Targeted therapy
4. Tyrosine kinase inhibitors for patients with Philadelphia chromosome (seen in one in four ALL patients).
5. Immunotherapy drugs
6. Stem cell transplant

The median overall survival with the existing therapeutics is approximately eight months.

Tecartus (brexucabtagene autoleucel) is a new and the only approved chimeric antigen receptor (CAR) T-cell therapy for ALL. Tecartus is an autologous, CD-19 targeted T-cell therapy developed by Kite, a Gilead company.

Currently, Tecartus is in a Phase 1/2 trial (ZUMA-3), and the European Commission has approved the drug based on the data observed. ZUMA -3 is a single-arm, open-label, multicenter trial targeting adult patients (≥18 years old) with relapsed or refractory ALL. The primary endpoint was overall complete remission or complete remission with incomplete hematological recovery.

71% of the patients showed no symptoms of cancer post-treatment when followed up for a median of 26.8 months, and their overall survival was almost four years. The median time for all patients to achieve remission was 18.6 months. The safety results were consistent with the previously obtained safety profile of Tecartus: 25% of patients showed cytokine release syndrome, and 32% of patients showed neurologic adverse reactions.

The other key emerging drugs for ALL are

1. JCAR017 (CAR T-cell therapy) by Celgene
2. Isatuximab (Anti-CD38 Monoclonal Antibody) by Sanofi
3. JZP-458 (recombinant Erwinia asparaginase) by Jazz Pharmaceuticals
4. Vyxeos (cytarabine and daunorubicin) by Jazz Pharmaceuticals
5. Daratumumab (anti-CD38 antibody) by Janssen Research and Development
6. Venetoclax (B-cell lymphoma-2 inhibitor) by Genentech