U.S. FDA Approves Label Update for Kite’s Yescarta® CAR T-Cell Therapy to Include Overall Survival Data
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Insights
The FDA's approval of a label update for Yescarta, based on the ZUMA-7 study's findings, represents a significant advancement in the treatment of relapsed or refractory large B-cell lymphoma (R/R LBCL). This update is not merely incremental; it reflects a 27.4% reduction in the risk of death compared to the standard of care (SOC), which is a substantial improvement in overall survival (OS) rates. The 39-month OS rates show a relative 38% improvement for patients treated with Yescarta.
From a medical standpoint, the transition from a multi-step SOC that culminates in autologous stem cell transplant (ASCT) to a single infusion of Yescarta simplifies the treatment regimen. This is particularly noteworthy given that less than 40% of patients typically complete the SOC process, while 94% of patients randomized to Yescarta in the study received treatment. This could lead to a paradigm shift in the second-line treatment of R/R LBCL, potentially establishing Yescarta as the new SOC.
The label update not only has the potential to affect patient outcomes but also carries implications for Kite's business performance. The enhanced efficacy of Yescarta could lead to increased adoption and market share, potentially impacting Gilead's revenue and positioning in the oncology market. Investors and stakeholders should monitor adoption rates and payer coverage decisions as indicators of the drug's commercial success.
Yescarta's label expansion to include overall survival data is a milestone in oncology, particularly for R/R LBCL, where treatment options have been limited. The statistically significant improvement in OS is clinically meaningful, as it suggests a higher likelihood of long-term remission for patients. The fact that over half of the SOC arm received cell therapy off protocol and Yescarta still demonstrated superior outcomes is noteworthy.
Understanding the clinical context, autologous stem cell transplant has been a cornerstone in the treatment of aggressive lymphomas, but its complexity and the physical toll it takes on patients mean that many are unable to complete the treatment. Yescarta's one-time infusion offers a less invasive and potentially more accessible treatment option, which could lead to better patient adherence and outcomes.
For healthcare providers, the updated label reinforces confidence in prescribing Yescarta as a second-line therapy. However, the cost of treatment, insurance coverage and the need for specialized centers capable of administering CAR T-cell therapies like Yescarta are factors that could affect its widespread adoption.
With the European Medicines Agency's recent approval of the Summary of Product Characteristics (SmPC) update and the FDA's label update for Yescarta, there is a clear indication of regulatory confidence in the treatment's efficacy. The landmark Phase 3 ZUMA-7 study serves as a robust foundation for these updates and may influence oncology treatment guidelines globally.
The business implications for Kite, a Gilead Company, are substantial. As the first and only treatment to demonstrate such a survival benefit in nearly three decades, Yescarta has the potential to capture a significant share of the R/R LBCL treatment market. The competitive landscape will likely respond, with other companies either seeking to develop competing therapies or potentially entering into partnerships or licensing agreements with Kite.
Investors should consider the long-term growth potential of Yescarta, factoring in the addressable patient population, pricing strategies and the potential for expansion into additional indications. The cost-effectiveness of the therapy, in comparison to the traditional multi-step treatment process, may also become a focal point in discussions with payers and healthcare providers.
-- Yescarta is the First and Only Treatment in Nearly 30 Years to Demonstrate Superior Overall Survival for Patients with Relapsed/Refractory Large B-cell Lymphoma Versus Standard of Care as Second-Line Treatment With Curative Intent* --
The label update is based on results from the ZUMA-7 study which demonstrated a
“This
SOC therapy for this patient population has historically been a multi-step process expected to end with stem-cell transplant. The process starts with chemoimmunotherapy, and if a patient responds and can tolerate further treatment, they move on to high-dose chemotherapy (HDT), followed by autologous stem cell transplant (ASCT). Despite this being the prior SOC, less than
Underscoring the Significance for Patients
As the first and only treatment in nearly 30 years to improve survival for patients with R/R LBCL in this setting, Yescarta can potentially change the standard of care for these patients who previously had limited options for long-term remission.
“Lymphoma Research Foundation has continuously supported efforts for the development of new treatments in large B-cell lymphoma with the shared goal of finding a cure,” said Meghan Gutierrez, Chief Executive Officer, Lymphoma Research Foundation. “We applaud Kite for bringing the oncology community one step closer to eradicating large B-cell lymphoma and offering new hope to patients.”
In November 2023, the European Medicines Agency approved an update to the Summary of Product Characteristics (SmPC) to include the ZUMA-7 overall survival analysis.
*Treatment of curative intent is a line of treatment administered with the goal of achieving a durable complete response/ remission. 2017. NIH National Library of Medicine “Curative, Life-Extending and Palliative Chemotherapy: New Outcomes Need New Names”
About ZUMA-7 Study
ZUMA-7 is a randomized, open-label, global, multicenter, Phase 3 study evaluating the safety and efficacy of Yescarta versus SOC for initial treatment of adult patients with R/R LBCL within 12 months of first-line therapy. In the study, 359 patients in 77 centers around the world were randomized (1:1) to receive a single infusion of Yescarta or prior SOC second-line treatment. The primary endpoint is EFS as determined by blinded central review and defined as the time from randomization to the earliest date of disease progression per Lugano Classification, commencement of new lymphoma therapy, or death from any cause. Key secondary endpoints include objective response rate (ORR) and OS. Additional secondary endpoints include patient reported outcomes (PROs) and safety. Per hierarchical testing of primary and key secondary endpoints and group sequential testing of OS, an interim analysis of OS occurred at the time of the primary EFS analysis. The prespecified primary OS analysis was to be conducted after 210 deaths or no later than five years after the first patient was randomized.
Yescarta demonstrated a 2.5-fold increase in patients who were alive at two years and did not experience cancer progression or require the need for additional cancer treatment (
Nearly three times as many patients randomized to Yescarta ultimately received the definitive CAR T-cell therapy treatment (
In the study, Yescarta had a safety profile that was consistent with previous studies. Among the 168 Yescarta-treated patients evaluable for safety, Grade ≥3 cytokine release syndrome (CRS) and neurologic events were observed in
The Yescarta
About Large B-Cell Lymphoma (LBCL)
Globally, LBCL is the most common type of non-Hodgkin lymphoma (NHL). In
About Yescarta (Axicabtagene Ciloleucel)
Please see full US Prescribing Information, including BOXED WARNING and Medication Guide.
YESCARTA is a CD19-directed genetically modified autologous T cell immunotherapy indicated for the treatment of:
- Adult patients with large B-cell lymphoma that is refractory to first-line chemoimmunotherapy or that relapses within 12 months of first-line chemoimmunotherapy.
-
Adult patients with relapsed or refractory large B-cell lymphoma after two or more lines of systemic therapy, including diffuse large B-cell lymphoma (DLBCL) not otherwise specified, primary mediastinal large B-cell lymphoma, high-grade B-cell lymphoma, and DLBCL arising from follicular lymphoma.
- Limitations of Use: YESCARTA is not indicated for the treatment of patients with primary central nervous system lymphoma.
- Adult patients with relapsed or refractory follicular lymphoma (FL) after two or more lines of systemic therapy. This indication is approved under accelerated approval based on the response rate. Continued approval for this indication may be contingent upon verification and description of clinical benefit in the confirmatory trial(s).
BOXED WARNING: CYTOKINE RELEASE SYNDROME AND NEUROLOGIC TOXICITIES
- Cytokine Release Syndrome (CRS), including fatal or life-threatening reactions, occurred in patients receiving YESCARTA. Do not administer YESCARTA to patients with active infection or inflammatory disorders. Treat severe or life-threatening CRS with tocilizumab or tocilizumab and corticosteroids.
- Neurologic toxicities, including fatal or life-threatening reactions, occurred in patients receiving YESCARTA, including concurrently with CRS or after CRS resolution. Monitor for neurologic toxicities after treatment with YESCARTA. Provide supportive care and/or corticosteroids as needed.
- YESCARTA is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the YESCARTA and TECARTUS REMS Program.
CYTOKINE RELEASE SYNDROME (CRS)
CRS, including fatal or life-threatening reactions, occurred. CRS occurred in
Key manifestations of CRS (≥
The impact of tocilizumab and/or corticosteroids on the incidence and severity of CRS was assessed in 2 subsequent cohorts of LBCL patients in ZUMA-1. Among patients who received tocilizumab and/or corticosteroids for ongoing Grade 1 events, CRS occurred in
Ensure that 2 doses of tocilizumab are available prior to YESCARTA infusion. Monitor patients for signs and symptoms of CRS at least daily for 7 days at the certified healthcare facility, and for 4 weeks thereafter. Counsel patients to seek immediate medical attention should signs or symptoms of CRS occur at any time. At the first sign of CRS, institute treatment with supportive care, tocilizumab, or tocilizumab and corticosteroids as indicated.
NEUROLOGIC TOXICITIES
Neurologic toxicities (including immune effector cell-associated neurotoxicity syndrome) that were fatal or life-threatening occurred. Neurologic toxicities occurred in
The most common neurologic toxicities (≥
The impact of tocilizumab and/or corticosteroids on the incidence and severity of neurologic toxicities was assessed in 2 subsequent cohorts of LBCL patients in ZUMA-1. Among patients who received corticosteroids at the onset of Grade 1 toxicities, neurologic toxicities occurred in
Monitor patients for signs and symptoms of neurologic toxicities at least daily for 7 days at the certified healthcare facility, and for 4 weeks thereafter, and treat promptly.
REMS
Because of the risk of CRS and neurologic toxicities, YESCARTA is available only through a restricted program called the YESCARTA and TECARTUS REMS Program which requires that: Healthcare facilities that dispense and administer YESCARTA must be enrolled and comply with the REMS requirements and must have on-site, immediate access to a minimum of 2 doses of tocilizumab for each patient for infusion within 2 hours after YESCARTA infusion, if needed for treatment of CRS. Certified healthcare facilities must ensure that healthcare providers who prescribe, dispense, or administer YESCARTA are trained in the management of CRS and neurologic toxicities. Further information is available at www.YescartaTecartusREMS.com or 1-844-454-KITE (5483).
HYPERSENSITIVITY REACTIONS
Allergic reactions, including serious hypersensitivity reactions or anaphylaxis, may occur with the infusion of YESCARTA.
SERIOUS INFECTIONS
Severe or life-threatening infections occurred. Infections (all grades) occurred in
Febrile neutropenia was observed in
In immunosuppressed patients, including those who have received YESCARTA, life-threatening and fatal opportunistic infections including disseminated fungal infections (e.g., candida sepsis and aspergillus infections) and viral reactivation (e.g., human herpes virus-6 [HHV-6] encephalitis and JC virus progressive multifocal leukoencephalopathy [PML]) have been reported. The possibility of HHV-6 encephalitis and PML should be considered in immunosuppressed patients with neurologic events and appropriate diagnostic evaluations should be performed.
Hepatitis B virus (HBV) reactivation, in some cases resulting in fulminant hepatitis, hepatic failure, and death, can occur in patients treated with drugs directed against B cells, including YESCARTA. Perform screening for HBV, HCV, and HIV in accordance with clinical guidelines before collection of cells for manufacturing.
PROLONGED CYTOPENIAS
Patients may exhibit cytopenias for several weeks following lymphodepleting chemotherapy and YESCARTA infusion. ≥ Grade 3 cytopenias not resolved by Day 30 following YESCARTA infusion occurred in
HYPOGAMMAGLOBULINEMIA
B-cell aplasia and hypogammaglobulinemia can occur. Hypogammaglobulinemia was reported as an adverse reaction in
SECONDARY MALIGNANCIES
Secondary malignancies may develop. Monitor life-long for secondary malignancies. In the event that one occurs, contact Kite at 1-844-454-KITE (5483) to obtain instructions on patient samples to collect for testing.
EFFECTS ON ABILITY TO DRIVE AND USE MACHINES
Due to the potential for neurologic events, including altered mental status or seizures, patients are at risk for altered or decreased consciousness or coordination in the 8 weeks following YESCARTA infusion. Advise patients to refrain from driving and engaging in hazardous occupations or activities, such as operating heavy or potentially dangerous machinery, during this initial period.
ADVERSE REACTIONS
The most common non-laboratory adverse reactions (incidence ≥
The most common adverse reactions (incidence ≥
The most common non-laboratory adverse reactions (incidence ≥
About Kite
Kite, a Gilead Company, is a global biopharmaceutical company based in
About Gilead Sciences
Gilead Sciences, Inc. is a biopharmaceutical company that has pursued and achieved breakthroughs in medicine for more than three decades, with the goal of creating a healthier world for all people. The company is committed to advancing innovative medicines to prevent and treat life-threatening diseases, including HIV, viral hepatitis and cancer. Gilead operates in more than 35 countries worldwide, with headquarters in
Forward-Looking Statements
This press release includes forward-looking statements, within the meaning of the Private Securities Litigation Reform Act of 1995 that are subject to risks, uncertainties and other factors, including the ability of Gilead and Kite to initiate, progress or complete clinical trials within currently anticipated timelines or at all, and the possibility of unfavorable results from ongoing or additional clinical studies, including those involving Yescarta; the possibility that Gilead and Kite may make a strategic decision to discontinue development of any programs for indications currently under evaluation and, as a result, these programs and/or indications may never be successfully commercialized; the risk that physicians may not see the benefits of prescribing Yescarta; and any assumptions underlying any of the foregoing. These and other risks, uncertainties and factors are described in detail in Gilead’s Quarterly Report on Form 10-Q for the quarter ended September 30, 2023, as filed with the
Kite, the Kite logo, Yescarta, and GILEAD are trademarks of Gilead Sciences, Inc. or its related companies.
For more information on Kite, please visit the company’s website at www.kitepharma.com. Follow Kite on social media on X ( @KitePharma ) and LinkedIn.
View source version on businesswire.com: https://www.businesswire.com/news/home/20231220595740/en/
Jacquie Ross, Investors
investor_relations@gilead.com
Meaghan Smith, Gilead Media
msmith@gilead.com
Anna Padula, Kite Media
apadula@kitepharma.com
Source: Gilead Sciences, Inc.
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