FDA Approves Breyanzi: First and Only CAR T-Cell Therapy for Relapsed or Refractory Marginal Zone Lymphoma

 

Breyanzi(lisocabtagene maraleucel) is a type of personalized cancer treatment called chimeric antigen receptor (CAR) T-cell therapy, which uses your modified T cells (white blood cells that help protect you from illness) to fight cancer. The FDA has approved Breyanzi for adults with a certain type of blood cancer known as marginal zone lymphoma (MZL) that has come back (relapsed) or hasn’t responded well to two or more previous therapies (refractory).

MZL is a rare slow-growing type of non-Hodgkin’s lymphoma (NHL) – a form of blood cancer. It arises from B cells or B lymphocytes (another type of white blood cells) found in the marginal zone of lymphoid tissues. MZL makes up about 7% of all NHL cases in the U.S., often affecting adults around 67 years old. It occurs when white blood cells gather and form lumps in the lymph nodes or other organs. Although initial treatment for the disease can help achieve remission, relapses are common and may happen often over several years. In a small number of cases, MZL can transform into diffuse large B-cell lymphoma, a more aggressive form of the disease.

During CAR T-cell therapy, your T cells are collected from your blood and genetically modified in a lab to better recognize and attack cancer cells. Then, these customized T cells are put back into your body through an intravenous (IV) infusion. As a CAR T-cell therapeutic agent, Breyanzi is designed to target a protein called CD19 found on many B-cell cancers and works by selectively destroying the harmful B cells.

This approval is important because Breyanzi is the first and only CAR T-cell therapy available in the U.S. for treating MZL. It offers people with this hard-to-treat cancer a new option when other treatments have stopped working.

First approved in 2021, Breyanzi has also been approved for the treatment of several other blood cancers that have come back or didn’t respond to earlier treatments, including large B-cell lymphoma, follicular lymphoma, mantle cell lymphoma, and chronic lymphocytic leukemia/small lymphocytic lymphoma.

Why Was It Approved?

The FDA approval for Breyanzi was based on a clinical study that showed that it was safe and effective in significantly reducing MZL in adults whose cancer had come back or had not responded after at least two previous treatments or after a stem cell transplant.

In this study, immune cells of 77 patients with relapsed or refractory MZL who had undergone two or more previous anticancer therapies were collected, and 66 of them went on to receive a single IV infusion of Breyanzi after completing their preparatory chemotherapy. Among these 66 patients, 95.5% responded to the therapy, and 62.1% had a complete response – meaning no signs of lymphoma were detected on imaging scans. After a median follow-up of 21.6 months, the median duration of response had not yet been reached, and 90.1% of those who responded were still in remission at 24 months, showing that the responses were long-lasting.

What Do I Need to Know?

Breyanzi is given as a one-time IV infusion. Before starting the treatment, your T cells will be collected through a process called leukapheresis and will be sent to the manufacturing site for creating personalized CAR T cells. However, before collecting your T cells, your health care provider may also test you for hepatitis B and C and HIV according to clinical guidelines. You’ll also get a short course of preparatory chemotherapy for three days before the infusion to help prepare your body. The whole process can take a few weeks.

After the infusion, you’ll need to stay close to a health care facility for at least two weeks. This is to make sure any side effects, like cytokine release syndrome (CRS) or nervous system problems, can be treated quickly if they happen. Your health care provider will check on you daily for at least the first week after treatment and will do blood tests throughout your treatment to monitor your progress.

You should avoid driving or using heavy machinery for at least two weeks after receiving Breyanzi since side effects, like confusion or dizziness, may show up later. Avoid donating blood, organs, tissues, or cells for transplantation.

Some people have developed other types of cancer, including T-cell cancers, after getting Breyanzi. Hence, lifelong monitoring is recommended.

Before receiving Breyanzi, tell your health care provider about any medical problems that you have or have had, including neurologic issues (like seizures, stroke, or memory loss); lung or breathing problems; heart, liver, or kidney issues; allergies; or any recent or ongoing infections. Also let them know about all your vaccinations and the medications, vitamins, and herbal supplements you take. It is recommended to avoid live virus vaccines for six weeks before preparatory chemotherapy, during treatment, and until your immune system recovers afterward.

The most common side effect is cytokine release syndrome (CRS), which is an immune reaction that can cause fever, low blood pressure, a fast or irregular heartbeat, and trouble breathing. Other side effects may include fatigue, fever (100.4 F/38 C or higher), chills or shaking, confusion, encephalopathy (a brain condition), slurred speech, severe nausea, vomiting or diarrhea, headache, dizziness or lightheadedness, infections, swelling, low blood pressure, and muscle pain. The most frequent changes in lab findings are low counts of lymphocytes, neutrophils, and other white blood cells; red blood cells; and platelets and low hemoglobin levels.

Breyanzi is not recommended if you are pregnant, and its effects on breastfeeding are not known. It may also affect certain lab test results, such as those for HIV, and could produce false-positive results.

Your health care provider will also guide you on how to watch for signs and symptoms of CRS and neurologic complications. Contact your health care provider or get emergency help right away if you have a fever, chills, trouble breathing, confusion, severe vomiting or diarrhea, a fast or irregular heartbeat, dizziness, unusual bleeding or bruising, or severe exhaustion or weakness. These could be signs of serious side effects.

Related Posts

Leave a Reply

Your email address will not be published. Required fields are marked *