Jeremy S. Abramson, MD
Jeremy S. Abramson, MD, Director of the Jon and JoAnn Hagler Center for Lymphoma at Massachusetts General Hospital and Associate Professor of Medicine at Harvard Medical School, Boston, commented on the study by Topp et al for The ASCO Post. “Earlier use of steroids with axicabtagene ciloleucel did indeed reduce the severity of toxicity compared with later steroids on the ZUMA-1 trial. The overall incidence of cytokine-release syndrome and neurotoxicity was not changed with early intervention, with any grade of cytokine-release syndrome occurring in 93% of patients, and neurotoxicity in approximately two-thirds. Notably, however, the incidence of severe toxicity was significantly lower than [that in] ZUMA-1,” Dr. Abramson said.
Dr. Abramson cautioned, however, that cohort 4—the focus of this analysis—had some differences vs the primary population of ZUMA-1. “Patients in the early-steroids cohort had a lower tumor burden and often received bridging therapy, which may also have played a role in reducing the severity of toxicity. But I do think that the earlier use of steroids does account for the majority of the risk reduction. And, of note, the response rates appear quite similar to [those in] the overall ZUMA-1 population,” he said. “This is an entirely reasonable strategy for reducing toxicity with axicabtagene ciloleucel.”
DISCLOSURE: Dr. Abramson has consulted for AbbVie, Amgen, Bayer HealthCare Pharmaceuticals, Celgene, EMD Serono, Genentech, Gilead Sciences, Janssen Biotech, Juno Therapeutics, Karyopharm Therapeutics, Kite Pharma, Merck, MorphoSys, and Novartis.
In patients with large B-cell lymphoma undergoing chimeric antigen receptor (CAR) T-cell therapy with axicabtagene ciloleucel, earlier-than-usual intervention with corticosteroids and tocilizumab may reduce the incidence of severe cytokine-release syndrome, according to the findings of a...