On November 8, 2024, the Food and Drug Administration sanctioned obecabtagene autoleucel (Aucatzyl, Autolus Inc.), a CD19-targeted genetically engineered autologous CAR T cell therapy, for people with relapsed or refractory B-cell precursor acute lymphoblastic leukemia (ALL).
Effectiveness and Safety
The efficacy was assessed in FELIX (NCT04404660), an open-label, multicenter, single-arm trial involving people with relapsed or refractory CD19-positive B-cell acute lymphoblastic leukemia (ALL). Enrolled patients were mandated to have experienced a relapse after a remission of 12 months or less, relapsed or refractory acute lymphoblastic leukemia (ALL) after two or more prior systemic therapies, or a relapse or refractory condition occurring three or more months post-allogeneic stem cell transplantation.
The primary efficacy outcome indicators were the rate and duration of complete remission (CR) attained within three months post-infusion. The supplementary outcome measures included the rate and duration of overall complete remission, encompassing both full remission and complete remission with incomplete hematologic recovery (CRi), at any point.
Among the 65 patients assessed for effectiveness, 27 patients (42%; 95% confidence interval [CI]: 29%, 54%) attained complete response (CR) within 3 months. The median duration of complete response attained within 3 months was 14.1 months (95% CI: 6.1, not reached).
The prescribing material includes a boxed warning for cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), and T cell malignancies. Cytokine Release Syndrome (CRS) manifested in 75% of cases (Grade 3, 3%), whereas neurological toxicities were observed in 64% (Grade ≥3, 12%), with Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) occurring in 24% (Grade ≥3, 7%).
The predominant non-laboratory adverse reactions (incidence ≥ 20%) encompassed CRS, unspecified infections, musculoskeletal pain, viral infections, fever, nausea, bacterial infections, diarrhea, febrile neutropenia, ICANS, hypotension, pain, fatigue, headache, encephalopathy, and hemorrhage.
The total recommended dosage of obecabtagene autoleucel is 410 x 10^6 CD19 chimeric antigen receptor (CAR)-positive viable T cells, to be administered as a split-dose infusion on Day 1 and Day 10 (±2 days), contingent upon an evaluation of bone marrow blasts and preceded by fludarabine and cyclophosphamide lymphodepleting chemotherapy.
Dr. Nishant Mittal is a highly accomplished researcher with over 13 years of experience in the fields of cardiovascular biology and cancer research. His career is marked by significant contributions to stem cell biology, developmental biology, and innovative research techniques.
Research Highlights
Dr. Mittal's research has focused on several key areas:
1) Cardiovascular Development and Regeneration: He studied coronary vessel development and regeneration using zebrafish models1.
2) Cancer Biology: At Dartmouth College, he developed zebrafish models for studying tumor heterogeneity and clonal evolution in pancreatic cancer.
3) Developmental Biology: His doctoral work at Keio University involved identifying and characterizing medaka fish mutants with cardiovascular defects.
4) Stem Cell Research: He investigated the effects of folic acid on mouse embryonic stem cells and worked on cryopreservation techniques for hematopoietic stem cells.
Publications and Presentations
Dr. Mittal has authored several peer-reviewed publications in reputable journals such as Scientific Reports, Cardiovascular Research, and Disease Models & Mechanisms1. He has also presented his research at numerous international conferences, including the Stanford-Weill Cornell Cardiovascular Research Symposium and the Weinstein Cardiovascular Development Conference.
In summary, Dr. Nishant Mittal is a dedicated and accomplished researcher with a strong track record in cardiovascular and cancer biology, demonstrating expertise in various model systems and a commitment to advancing scientific knowledge through innovative research approaches.
