New treatment against one of the most aggressive blood cancers

Large B-cell lymphoma (acronym DLBCL) is one of the most common and aggressive types of lymphoma occurring in adults, accounting for 30% to 40% of non-Hodgkin lymphoma cases.

A phase III study, called ZUMA-7, shows that a new treatment with the drug Yescarta (axicabtagen ciloleucel, known as axicel) reduces the risk of death by 27.4%, which means a relative improvement of 38% in overall survival of patients with primarily refractory or early relapsed large B-cell lymphoma.

This is the first treatment, after 30 years, that has been shown to improve the overall survival of patients compared to the standard treatment that has been used.

The study was carried out by an international team headed by Jason R. Westin of the University of Texas MD Anderson Cancer Center in the United States, and which also includes, among others, Anna Sureda, group leader of the Biomedical Research Institute of Bellvitge (IDIBELL), located in Hospitalet de Llobregat and which is one of the CERCA institutions of the Generalitat of Catalonia, and head of the Clinical Hematology Service of the Catalan Institute of Oncology.

What is Axicabtagen ciloleucel?

It is a drug that is used for the treatment of lymphoma after conventional therapy has not given the expected results. It is a treatment with CAR-T cells, a type of immunotherapy in which the patient’s own cells are extracted, manipulated in the laboratory, and reintroduced into the patient so that they can fight tumor cells.

This drug was approved by both the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) for the purpose of treating patients with diffuse large B-cell lymphoma who had failed two or more prior lines of treatment. Subsequently, in October 2022, both institutions approved its administration as a second line of therapy in patients with this type of cancer that was primarily refractory or did not respond to initial treatment.

Dr. Anna Sureda. (Photo: IDIBELL)

An increase in survival of almost 30%

Until now, patients with diffuse large B-cell lymphoma were treated with second-line salvage chemotherapy, and those who achieved complete or partial remission were consolidated with high-dose chemotherapy followed by autologous transplantation (autologous transplantation). However, less than 40% of the patients reached the transplant phase, compared to 94% of the patients in the ZUMA-7 study who received treatment with axicel.

At the present time, and after 4 years of follow-up of the patients included in the Phase III ZUMA-7 study, it has been possible to observe a significant improvement in survival compared to what was achieved by the treatment that was done up to now, with a 27.4% reduction in the risk of death, which corresponds to a 38% improvement in survival of this type of patients within the completion of treatment

“Patients who are primarily refractory or in early relapse (in the first 12 months) have a very poor long-term prognosis and their survival with autologous transplantation does not exceed 20%. These patients will benefit from the introduction of the new treatment with axi-cell”, explains Anna Sureda. She is also convinced that these results open up a therapeutic alternative for patients with relapsed or early refractory DLBCL since it has a higher percentage of survival compared to platinum-based chemotherapy treatment and subsequent autologous stem cell transplantation.

The study is titled “Survival with Axicabtagene Ciloleucel in Large B-Cell Lymphoma”. And it has been published in the New England Journal of Medicine. The results have also been presented at the American Society of Clinical Oncology (ASCO) congress held recently in the US city of Chicago. (Source: IDIBELL)