CCSC: Good news spreads frequently, long-term benefit, CAR-T curative effect sees the truth

Chimeric antigen receptor T cell (CAR-T) therapy, as a disruptive innovative therapy, is booming in China
.

On June 22, 2021, Yikaida® (Akilunza injection) was formally approved by the National Medical Products Administration (NMPA), becoming China’s first CAR-T therapy drug targeting CD19 for the treatment of previously accepted drugs Adult patients with relapsed or refractory large B-cell lymphoma (R/R LBCL) after second-line or above systemic treatment have brought new treatment options for R/R LBCL
.

At present, it has been approved in 38 countries around the world, and has accumulated nearly 5,000 patient experience
.

In order to promote the development of China's CAR-T field, build China's CAR-T star treatment center, and cooperate with international and domestic diagnosis and treatment
.

"CCSC (China CAR-T Star Center)-Kylinhui International Connection" continues! The new phase of Kylin Club International Connection was successfully held
.

This conference has the honor to invite Professor Huang Huiqiang from Sun Yat-sen University Cancer Hospital, Professor David B.
Miklos from Stanford University Medical Center, Dr.
Gao Yan from Sun Yat-sen University Cancer Hospital, and many top domestic experts as conference speakers and discussion guests, focusing on CAR-T cells For cutting-edge topics in the therapeutic field, we will conduct in-depth discussions and exchanges on Fosun Kate’s CAR-T cell therapy drug Yikaida® (Akirensai Injection)
.

Below, I will take you to review the wonderful links of this conference.
I hope that this conference can expand clinicians' understanding of the clinical efficacy of Akirensai injection and further improve the clinical benefits of patients
.

International CAR-T Therapy-Experienced and Long Benefits In this session, Professor David B.
Miklos from Stanford University Medical Center gave a speech entitled "A Cure is Possible: Axi-Cel data and Real-World Experience"
.

Professor David B.
Miklos first gave a general introduction to the structure and advantages of CAR-T cells and showed us the Stanford Center for Tumor Cell Therapy, which was established in 2016
.

Later, Professor David B.
Miklos introduced the mechanism of action, clinical indications, treatment procedures, clinical research and adverse reactions of Akirensai injection as a CAR-T therapy
.

The ZUMA-1 study showed that CAR-T treatment of R/R LBCL patients has significant benefits in terms of progression-free survival (PFS) and overall survival (OS).
In terms of long-term efficacy, the 3-year OS rate can reach 47%, real world data It also showed consistent results, with a 3-year PFS rate of 37% and a 3-year OS rate of 52%
.

Compared with other CAR-T drugs, Akirensai injection also has obvious survival benefits
.

Based on the current real-world data, Professor David B.
Miklos has made his own opinions on the dosage of CAR-T treatment, the choice of bridging treatment, the management of cytokine release syndrome (CRS), and the management of 30 days after CAR-T treatment.
Recommended
.

With the passage of time, 1 to 2 years after treatment, the patient's risk of infection will gradually increase, especially in the current situation of COVID-19, vaccination should be carried out before and after CAR-T treatment
.

Finally, regarding the reasons for the failure of CAR-T treatment, Professor David B.
Miklos believes that the loss of CD19 antigen is the main reason.
At the same time, the phenotype of CAR-T cells is also related to toxicity and long-lasting response
.

Discussion experts discussed the sharing of Professor David B.
Miklos
.

Professor Liu Hui from the Second Affiliated Hospital of Zhejiang University School of Medicine raised questions about the use of granulocyte colony stimulating factor (GCSF) and the use of the COVID-19 vaccine
.

Professor David B.
Miklos stated that GCSF is recommended for the first 7 days in the ZUMA-1 study.
Although the current study does not show that the use of GCSF is significantly related to neurotoxicity, the cost and risk of infection have caused most research centers to stop using it; if you wait for patients It takes about 18 months for immune function to recover.
At present, the US government stipulates that patients need to be vaccinated again after 3 months of CAR-T treatment.
For patients who have been infected, monoclonal antibody treatment should be actively used
.

Professor Huang Huiqiang raised questions about the treatment of the patient's relapse
.

Professor David B.
Miklos said that for patients with local recurrence, CD22 CAR-T treatment is currently the main choice.
CD79 CAR-T has shown good efficacy in clinical studies.
In the future, multi-target CAR-T should be used to treat relapsed patients.
There is a certain prospect
.

Dr.
Gao Yan raised questions about ctDNA testing after CAR-T treatment
.

Professor David B.
Miklos stated that he highly recommends the use of ctDNA testing to monitor the risk of recurrence in treatment, and the U.
S.
Food and Drug Administration (FDA) will soon approve this recommendation
.

Domestic CAR-T treatment-benefit after the fifth line.
In this session, Dr.
Gao Yan made a case sharing entitled "A Case of Refractory Diffuse Large B-Cell Lymphoma"
.

This case is a 59-year-old male patient.
In September 2019, there was no obvious cause for a left anterior chest wall mass with post-movement pain.
Through biochemical routine, PET/CT examination, pathological examination and immunohistochemistry, the diagnosis was (primary Bone) Diffuse large B-cell lymphoma (NOS, GCB subtype)
.

The patient underwent four courses of first-line R-CHOP chemotherapy (rituximab + cyclophosphamide + doxorubicin + vincristine + prednisone), and second-line ICE chemotherapy (isosulfonamide + carboplatin + etoposide) ) Four courses of treatment, two courses of third-line lenalidomide, two courses of fourth-line ibrutinib combined with Verbutuximab (BV), and radiotherapy, which made the lesions significantly smaller, but PFS only maintained Within 3 months, multiple recurrences occurred throughout the body.
Five-line gemcitabine combined with paclitaxel had no effect after two courses of treatment, and the disease progressed
.

CAR-T treatment started on September 6, 2021, and PET/CT examination on October 11 showed complete remission (CR), and the adverse reactions were mostly grade 1-2.
It can be seen that CAR-T can be used in patients with refractory lymphoma.
There are obvious advantages in treatment
.

The participating experts discussed the sharing of Dr.
Gao Yan
.

Professor Ji Dongmei from the Cancer Hospital of Fudan University believes that Dr.
Gao Yan’s sharing provides a very good experience for CAR-T treatment of patients with skeletal lymphoma, and also gives him great confidence in clinical CAR-T treatment
.

Professor Hu Yongxian from the First Affiliated Hospital of Zhejiang University School of Medicine raised questions about the preparation of CAR-T cells.
Professor Huang Huiqiang said that the patient's own condition is good, the number of lymphocytes is large, and the curative effect will be better, so pay attention to patients before CAR-T treatment The number of lymphocytes is an important issue
.

Professor Zhang Mingming of the First Affiliated Hospital of Zhejiang University School of Medicine raised questions about the treatment of large lesions and the possible pretreatment of later recurrence.
Dr.
Gao Yan said that he should try to do CAR-T treatment when the patient’s tumor burden is low in order to obtain better curative effects.
The pretreatment of recurrence requires further clinical research
.

Summary At the end, Professor Huang Huiqiang made a summary of the meeting
.

I would like to thank Professor David B.
Miklos and Dr.
Gao Yan for sharing their experience.
I hope that CAR-T treatment will have more clinical research progress, which will provide a more direct reference for the clinical use of CAR-T treatment and contribute to the development of CAR-T treatment in China.
Further, work together to improve the CAR-T treatment plan, and ultimately change the treatment ecology in the field of lymphoma and hematology, and achieve long-term and good survival benefits for patients! Poke "read the original text", we make progress together