B-cell maturation antigen (BCMA)-directed chimeric antigen receptor (CAR) T-cell therapy, NXC-201, has demonstrated promising efficacy in patients with light chain (AL) amyloidosis, according to data presented at the American Society of Hematology meeting. The study, which involved heavily pretreated patients, showed a 100% hematologic response rate, although concerns remain regarding patient survival.
The NEXICART-1 study evaluated NXC-201 in nine patients with a median of six prior lines of therapy. The results indicated that all patients achieved a hematologic response, with six patients experiencing complete hematologic responses. The median time to hematologic response was less than one month. Cytokine release syndrome (CRS) was generally mild, with grades 1 and 2 reported.
However, despite the high response rate, six patients died during the median follow-up of seven months. One death was attributed to COVID-19 pneumonia, while the causes of the other deaths were not specified in the provided source. This raises concerns about the long-term survival benefits of the therapy in this patient population.
Potential and Challenges
The findings suggest that NXC-201 could offer a potential "one-shot solution" for achieving durable hematologic responses and potentially improving organ responses in AL amyloidosis. This is particularly relevant given the challenges in managing this complex disease, which often requires ongoing treatment and can lead to significant organ damage.
Despite the optimism, the study also highlights existing challenges, including concerns about cardiac progression and immune fitness in patients with extensive prior therapy. Further research is needed to determine the optimal patient selection criteria and strategies to improve long-term outcomes with NXC-201 in AL amyloidosis.
