The number of autologous chimeric antigen receptor (CAR) T-cell therapy undergoing testing for chronic lymphocytic leukaemia (CLL) demonstrates the promise for this treatment, according to a new analysis.
Compiled by the London-based data analytics company GlobalData, the report covers the current situation as well as promising therapies based on this approach.
Overall, CAR-T therapy is a very promising treatment for CLL, say oncology analyst Sam Warburton and colleagues at GlobalData. However they add that significant clinical challenges remain.
At present, there are 44 CAR-T therapies under investigation for CLL, despite the complications faced by autologous treatments. Often the patient’s T cells are not suitable for this purpose.
Among the treatments currently in use, the anti-CD19 CAR-T therapy tisagenlecleucel (sold as Kymriah by Novartis) has produced the longest remission. Two patients with end-stage refractory disease received the drug in 2010 and were still alive and in remission this year.
The report states that this “demonstrates to the industry that long-term remission is indeed possible”. Nevertheless, there are still no approved CAR-T therapies for this condition.
“Patients with end-stage chronic lymphocytic leukaemia have yet to benefit from an approved cell therapy,” said Mr Warburton, “despite many developers initially trialling autologous CAR-T agents such as Kymriah and Yescarta during Phase I studies.”
On the other hand, he says: “Autologous CAR-T agents are now becoming the standard of care for non-Hodgkin lymphoma and acute lymphocytic leukaemia patients in the third line and later settings.
“Such positive results mean that such indications are prioritised over chronic lymphocytic leukaemia patients, who continue to miss out on these benefits.”
In addition, current standards-of-care for CLL like ibrutinib and rituximab are well-tolerated and effective, which means that cellular therapies like CAR-T are likely to be “relegated” to refractory or end-stage patients for some time, according to GlobalData.
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