Bristol Myers Squibb's CAR T cell therapy Breyanzi has received expanded approval from the European Commission for the treatment of adults with relapsed or refractory follicular lymphoma (FL) who have received two or more lines of systemic therapy, marking a significant advancement in treatment options for this patient population.
The approval is based on results from the Phase II TRANSCEND FL trial, the largest study to date evaluating a CAR T cell therapy in patients with relapsed or refractory indolent non-Hodgkin lymphoma, including follicular lymphoma. The therapy demonstrated remarkable efficacy, achieving a 97.1% overall response rate (the trial's primary endpoint) and a 94.2% complete response rate (a secondary endpoint) in the third-line setting and beyond.
Emma Charles, Senior Vice President of BMS Europe Region, emphasized the significance of this approval: "This additional approval for Breyanzi in FL represents a critical step forward in our mission to deliver on the transformational promise of cell therapy for more patients across Europe. While significant advancements have been made in the last two decades, there still remains unmet need for patients."
Understanding Follicular Lymphoma and Treatment Challenges
Follicular lymphoma is a slow-growing form of non-Hodgkin lymphoma that affects the B-cells of the immune system. Despite being indolent in nature, FL remains largely incurable with conventional therapies, and patients who experience multiple relapses face diminishing treatment options and outcomes with each subsequent line of therapy.
Current standard treatments for FL include chemotherapy, immunotherapy, and targeted therapies. However, patients who relapse after multiple lines of treatment often develop resistance to conventional approaches, highlighting the need for innovative therapeutic strategies like CAR T cell therapy.
Breyanzi's Mechanism of Action and Administration
Breyanzi (lisocabtagene maraleucel) is a CD19-directed chimeric antigen receptor (CAR) T cell therapy that works by genetically re-engineering a patient's own T cells to recognize and attack cancer cells that express the CD19 protein, which is commonly found on B-cell lymphomas.
The treatment is administered as a single infusion following a lymphodepleting chemotherapy regimen. Unlike traditional ongoing treatments, CAR T cell therapy is designed as a one-time treatment with potential for durable responses, offering a significant advantage for heavily pretreated patients.
Clinical Evidence Supporting Approval
The TRANSCEND FL trial provided robust evidence for Breyanzi's efficacy in this patient population. The high complete response rate of 94.2% is particularly noteworthy, as achieving complete remission is associated with improved long-term outcomes in follicular lymphoma.
The safety profile observed in the trial was consistent with the known safety profile of Breyanzi in other approved indications, with cytokine release syndrome and neurological events being the most significant potential adverse events, though management protocols are well-established.
Regulatory Status and Availability
This approval extends to all European Union member states, as well as Norway, Liechtenstein, and Iceland. The centralized marketing authorization does not include the United Kingdom, though Breyanzi has separately received approval there for several lymphoma indications.
Breyanzi has also secured approvals for various lymphoma indications in Switzerland, Canada, and Japan, demonstrating its growing global acceptance as an important therapeutic option for difficult-to-treat lymphomas.
Expanding CAR T Cell Therapy Access
The approval represents part of a broader trend of expanding access to CAR T cell therapies across Europe. While these therapies were initially approved for aggressive lymphomas, their application is now extending to more indolent lymphomas like FL, where they may provide significant clinical benefit for patients with limited options.
Bristol Myers Squibb has been strengthening its position in the cell therapy space, recently agreeing to acquire its longtime cell therapy partner 2seventy bio for $286 million, further demonstrating the company's commitment to advancing this therapeutic approach.
Future Implications for Lymphoma Treatment
This approval may signal a shift in the treatment paradigm for follicular lymphoma, potentially moving CAR T cell therapy to earlier lines of treatment if long-term follow-up data continue to show durable responses with manageable safety profiles.
For patients with relapsed or refractory follicular lymphoma who have exhausted multiple lines of therapy, Breyanzi now offers a promising option with the potential for deep and lasting remissions, addressing a significant unmet need in this patient population.
