Blood cancers

Second CAR T cell therapy gets public funding for B cell lymphomas

A/Prof Michael Dickinson

CAR-T cell therapy axicabtagene ciloleucel (Yescarta) is now funded for four types of non-Hodgkin lymphoma patients in select Australian public hospitals.

From 5 August, selected patients with relapsed or refractory CD19-positive diffuse large B cell lymphoma (DLBCL), primary mediastinal large B cell lymphoma, transformed follicular lymphoma or high grade B cell lymphoma will be able to access the treatment at Melbourne’s Peter MacCallum Cancer Centre and Brisbane’s Royal Brisbane and Women’s Hospital.

Under the eligibility criteria, around 200–400 patients could access the treatment per year, according to  Associate Professor Michael Dickinson, Lead of Aggressive Lymphoma at Peter MacCallum Cancer Centre and Royal Melbourne Hospital.

“Axicabtagene ciloleucel provides a valuable option for patients with some of the most aggressive types of non-Hodgkin lymphoma. Many patients with these aggressive forms of non-Hodgkin lymphoma – who have not responded to commonly available treatment options – have a very poor prognosis so there is an urgent need for new therapy options for these patients,” he said

And early referral of potentially eligible patients to CAR T-cell centres would be key to helping patients get the most out of this treatment, he told the limbic.

“The earlier those patients are considered for CAR-T, the better use we’ll make of this service for Australian patients. So early referral and early conversations with the CAR-T treatment centre are absolutely key in making these treatments available for your patients,” he said.

A key message for haematologists is in recognising the best moment to refer their patient, which is usually at their second or subsequent relapse, but the earlier the better, he added.

“That gives us the best chance of this sort of treatment providing a benefit for the patient.”

Axicabtagene ciloleucel is produced by Kite, a Gilead Company, and follows tisagenlecleucel (Kymriah) from Novartis as Australia’s second publicly-subsidised CAR-T cell therapy for patients with certain aggressive relapsed or refractory B-cell lymphomas.

Currently, eligible patients can access axicabtagene ciloleucel at hospitals in Brisbane and Melbourne, with Sydney centres anticipated in the near future, while tisagenlecleucel is available to patients in Perth, Brisbane, New South Wales and Victoria, Associate Professor Dickinson said.

While COVID-19 has made travelling difficult, the state governments and CAR T-cell centres have been working to ensure patients get access to this potentially life-saving therapy and get special travel exemptions where necessary, according to Associate Professor Dickinson.

CAR-T centres have also reached patients and their specialists via telehealth to ensure quality and continuity of care, he said.

Despite being manufactured in the US, axicabtagene ciloleucel turn-around times have been similar to pre-COVID, generally taking three to four weeks to fly off and return back.

Associate Professor Dickinson said CAR T-cell clinical trials are currently underway across a range of haematologic malignancies, and he expected myeloma to be the next approved indication.

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