Brexucabtagene autoleucel is approved by FDA for relapsed or refractory B-cell precursor acute lymphoblastic leukemia

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October 2021: Brexucabtagene autoleucel (Tecartus, Kite Pharma, Inc.) has been approved by the Food and Drug Administration for adult patients with relapsed or refractory B-cell precursor acute lymphoblastic leukaemia (ALL).

In ZUMA-3 (NCT02614066), a single-arm multicenter trial in individuals with relapsed or refractory B-cell precursor ALL, the efficacy of brexucabtagene autoleucel, a CD19-directed chimeric antigen receptor (CAR) T-cell treatment, was assessed. Following lymphodepleting chemotherapy, patients received a single infusion of brexucabtagene autoleucel.

Complete response (CR) within 3 months of infusion and durability of CR were the efficacy outcome criteria utilised to support approval. Within three months, 28 (52 percent; 95 percent CI: 38, 66) of the 54 patients evaluable for effectiveness attained CR. The median duration of CR was not met with a median follow-up of 7.1 months for responders; the length of CR was anticipated to surpass 12 months for more than half of the patients.

A boxed warning for cytokine release syndrome (CRS) and neurologic toxicities is included in the prescribing material for brexucabtagene autoleucel. In 92 percent of cases (Grade 3, 26 percent), CRS developed, and in 87 percent of cases (Grade 3, 35 percent), neurologic toxicities occurred. Fever, CRS, hypotension, encephalopathy, tachycardias, nausea, chills, headache, fatigue, febrile neutropenia, diarrhoea, musculoskeletal pain, hypoxia, rash, edoema, tremor, infection with an unspecified pathogen, constipation, decreased appetite, and vomiting were the most common non-laboratory adverse reactions (incidence 20%).

A single intravenous infusion of 1 x 106 CAR-positive viable T cells per kg body weight (maximum 1 x 108 CAR-positive viable T cells) is advised for brexucabtagene autoleucel treatment, followed by fludarabine and cyclophosphamide for lymphodepleting chemotherapy.

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