Autolus Therapeutics has received U.S. Food and Drug Administration (FDA) approval for AUCATZYL® (obecabtagene autoleucel), a CAR T-cell therapy, for treating adult patients with relapsed or refractory B-cell precursor acute lymphoblastic leukemia (r/r B-ALL). This approval marks a significant advancement in the treatment of this aggressive cancer, offering new hope for patients with limited options. The approval was based on the promising results of the FELIX clinical trial.
FELIX Trial Results
The FDA's decision was supported by data from the FELIX clinical trial, which evaluated the efficacy and safety of obe-cel in adult patients with r/r B-ALL. The trial demonstrated a strong safety profile compared to existing CD19 CAR T-cell therapies. Key findings from the FELIX trial include:
- In 65 efficacy-evaluable patients, 63% achieved overall complete remission (OCR).
- 42% of patients achieved complete remission within three months.
- The median duration of remission (DOR) was 14.1 months.
- The therapy showed low levels of Cytokine Release Syndrome (CRS), with only 3% Grade 3 events and no Grade 4 or 5 events.
- Grade ≥ 3 Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) was reported in 7% of patients.
Notably, AUCATZYL is the first CAR T-cell therapy approved by the FDA without requiring a Risk Evaluation and Mitigation Strategy (REMS) program, typically implemented for drugs with serious safety concerns.
Clinical Significance
Adult ALL is an aggressive form of blood cancer, with approximately 8,400 new cases diagnosed annually in the US and EU. Around 3,000 of these patients are in the relapsed refractory setting. Survival rates are poor in adult r/r ALL, with a median overall survival of only eight months. AUCATZYL offers a much-needed new treatment option for these patients.
Dr. Elias Jabbour, U.S. lead investigator of the FELIX study and professor at The University of Texas MD Anderson Cancer Center, stated, "Adult ALL is an extremely aggressive cancer, and there is a high unmet medical need that exists in the treatment of patients with this disease once they relapse, where historically they suffer from poor outcomes. This milestone approval, based on the demonstrated clinical benefit of AUCATZYL, brings new hope for adult patients with relapsed/refractory B-ALL."
Manufacturing and Global Supply
AUCATZYL will be manufactured at Autolus' commercial manufacturing site in Stevenage, UK. This facility has received a Manufacturer's Importation Authorization (MIA) and a GMP certificate from the U.K. Medicines and Healthcare products Regulatory Agency (MHRA). The Nucleus facility will supply AUCATZYL globally, with Cardinal Health serving as Autolus' commercial distribution partner in the U.S.
Safety Information
The safety label for AUCATZYL includes a boxed warning for Cytokine Release Syndrome (CRS), neurologic toxicities, and secondary hematological malignancies. ICANS, including fatal or life-threatening reactions, can occur. T-cell malignancies have also been reported following treatment with BCMA- and CD19-directed genetically modified autologous T-cell immunotherapies. Common adverse reactions (incidence ≥ 20%) include CRS, infections, musculoskeletal pain, viral infections, fever, nausea, bacterial infectious disorders, diarrhea, febrile neutropenia, ICANS, hypotension, pain, fatigue, headache, encephalopathy, and hemorrhage.
Future Directions
Marketing authorisation applications (MAAs) for obe-cel in adult r/r ALL are currently under review by regulators in both the EU and the UK. Submissions have been accepted by the European Medicines Agency (EMA) and the UK MHRA.
