Jason Westin, MD, MS, FACP, director of the Lymphoma Clinical Research Program at the University of Texas MD Anderson Cancer Center, gave insight the ZUMA-7 trial of axicabtagene ciloleucel (axi-cel) in relapsed or refractory large B-cell lymphoma (R/R LBCL) and the study's implications in the broader LBCL landscape.
Jason Westin, MD, MS, FACP, director of the Lymphoma Clinical Research Program at Texas MD Anderson Cancer Center, gave insight into overall survival findings from the ZUMA-7 trial of axicabtagene ciloleucel (axi-cel) in relapsed or refractory large B-cell lymphoma (LBCL) and their implications in the broader LBCL landscape.
The full findings are being presented in an oral presentation Monday at the 2023 American Society of Clinical Oncology (ASCO) Annual Meeting.
Can you discuss the significance of the overall survival outcomes among patients treated with axi-cel vs the standard of care in ZUMA-7?
Axi-cel is a CAR T cell targeting CD19, and it has approvals in third line and now in second line for patients with large B cell lymphoma. In the ZUMA-7 clinical trial, we showed a significant improvement in event-free survival, and here at the ASCO 2023 meeting, we're showing an improvement in overall survival. This is the first time that, in the curative intent setting in second line, there has been improvement in overall survival for nearly 30 years. So we're pretty excited about that finding.
Can you describe response and complete response rates among patients who received axi-cel compared with standard-of-care therapy?
In the ZUMA-7 clinical trial, complete response rates were significantly higher in the axi-cel arm versus standard-of-of care arm—nearly double the difference. In the axi-cel arm, it was north of 60% of patients had a complete response vs chemotherapy was around 30%. That's important because, for patients who are on the standard-of-care arm, chemotherapy usually leads to high dose therapy and autologous transplant if you respond to treatments. So on the axi-cel arm, 94% of patients received what we call definitive therapy, which was the CAR T cell. On the standard-of-care arm, it was only 36%. So, nearly 3-fold difference in patients who could receive the intended curative therapy between these arms on the ZUMA-7 trial.
What implications do these findings have in the broader LBCL treatment landscape?
The axi-cel arm on the ZUMA-7 clinical trial showed that more patients live longer if they receive axi-cel as a second-line treatment. The debate in the lymphoma world for 3 decades there has been an establishment of standard of care chemotherapy followed by [autologous stem cell] transplant. Over the past few years there has been a debate of is second-line CAR T cell the preferred approach, or should you try chemo in second-line and if it doesn't work, then use CAR T cell as a backup?
On our trial, we showed definitively that CAR T-cell [therapy] in the second line is the preferred approach, because on the standard of care on ZUMA-7, more than half of the patients did not respond to chemo and went on to get a subsequent cellular immunotherapy—57% did that and still had a significant improvement in overall survival. So effectively, saving CAR T cell for later is an inferior approach, and axi-cel should be a second-line treatment option.