89 percent of patients evaluable for MRD assessment
were MRD negative, with the majority reaching MRD negativity in
less than 2 months
Results add to the overall survival (OS) benefits recently
presented, as the first and only cell therapy to significantly
extend OS versus standard therapies in multiple myeloma
SAN
DIEGO, Dec. 9, 2024 /PRNewswire/ -- Johnson &
Johnson (NYSE:JNJ) announced today new results from the Phase 3
CARTITUDE-4 study that show a single infusion of
CARVYKTI® (ciltacabtagene autoleucel; cilta-cel)
significantly increased minimal residual disease (MRD) negativity
rates (10-5) in patients with relapsed or refractory
multiple myeloma (RRMM) who were lenalidomide-refractory and had
received one to three prior lines of therapy, including a
proteasome inhibitor (PI), compared to standard therapies of
pomalidomide, bortezomib and dexamethasone (PVd) or daratumumab,
pomalidomide and dexamethasone (DPd).1 MRD is a
prognostic marker of prolonged survival outcomes for patients with
multiple myeloma. These results add to the overall survival (OS)
benefits recently presented at the International Myeloma
Society meeting earlier this year, as the first and only cell
therapy to significantly extend OS versus standard therapies for
patients with multiple myeloma.1 Findings were
featured in an oral presentation at the 2024 American Society of
Hematology (ASH) Annual Meeting (Abstract #1032).1
"CARVYKTI has established its significant impact on overall
survival and improved progression-free survival compared to
standard therapies," said Rakesh
Popat, M.D., University College London Hospitals, NHS
Foundation Trust, London, UK, and
lead study investigator.* "The MRD negativity results demonstrate
deep responses compared to standard therapies for people living
with multiple myeloma and further underscore the benefit of
CARVYKTI, administered as a single infusion as early as second
line."
The Phase 3 CARTITUDE-4 study
evaluated CARVYKTI® compared to standard therapies
of PVd or DPd for the treatment of patients with RRMM as early as
after one prior line of therapy.1 Patients who
received one to three prior lines of therapy, including a PI and
immunomodulatory agent (IMiD), and were lenalidomide-refractory,
were randomized (CARVYKTI®, n=208, standard therapies,
n=211).1 At a median follow-up of almost three
years (34 months), MRD-negativity rates for evaluable patients were
more than double in those treated with CARVYKTI® versus
standard therapies (89 percent, 38 percent;
P<0.0001).1 At 2.5 years, sustained (12
months or more), MRD-negative complete response or better in
evaluable patients treated with CARVYKTI® was
five-fold higher than that of standard therapies (52 percent,
10 percent; P<0.0001). A post-hoc comparison between
CARTITUDE-4 and CARTITUDE-1 was also presented, comparing earlier
treatment (1-3 versus 3+ prior lines of therapy) demonstrating
higher rates of MRD negativity, progression-free survival (PFS) and
OS rates when CARVYKTI® is used earlier in
treatment.
"We are thrilled to present the latest MRD negativity results
from the CARTITUDE-4 study showing that CARVYKTI, the first
and only cell therapy approved for the treatment of patients with
multiple myeloma as early as second line, shows profound long-term
remission rates, including progression-free survival and overall
survival benefits," said Jordan
Schecter, M.D., Vice President, Disease Area Leader,
Multiple Myeloma, Johnson & Johnson Innovative Medicine. "It is
also increasingly clear that reaching MRD negativity is a key goal
with CAR-T therapy in myeloma, and we see that MRD rates were
higher in this analysis with earlier treatment."
Additional data on patient reported outcomes (PROs) and time to
worsening (TTW) of symptoms with CARVYKTI® will also be
presented at ASH 2024 as a poster presentation (Abstract
#2002).2 Based on the Multiple Myeloma Symptom and
Impact Questionnaire (MySlm-Q) system and impact domain
scores, patients treated with CARVYKTI® reported
significantly longer TTW of symptoms compared to standard
therapies.2 At three-year follow up, 83 percent of
patients treated with CARVYKTI® had not experienced
worsening of functional impacts, compared to 69 percent in the
standard therapies arm.2
About CARTITUDE-4
CARTITUDE-4 (NCT04181827) is the first randomized Phase 3 study
evaluating the efficacy and safety of CARVYKTI®. The
study compares CARVYKTI® with standard of care
treatments PVd or DPd in adult patients with relapsed and
lenalidomide-refractory multiple myeloma who received one to three
prior lines of therapy. The primary endpoint of the study
is PFS; safety, OS, MRD negativity rate and overall response
rate are secondary endpoints.
About CARVYKTI® (ciltacabtagene autoleucel;
cilta-cel)
CARVYKTI® is a BCMA-directed, genetically modified
autologous T-cell immunotherapy that involves reprogramming a
patient's own T-cells with a transgene encoding chimeric antigen
receptor (CAR) that directs the CAR-positive T cells to eliminate
cells that express BCMA. BCMA is primarily expressed on the surface
of malignant multiple myeloma B-lineage cells, as well as
late-stage B cells and plasma cells. The CARVYKTI® CAR
protein features two BCMA-targeting single domains designed to
confer high avidity against human BCMA. Upon binding to
BCMA-expressing cells, the CAR promotes T-cell activation,
expansion, and elimination of target cells.
CARVYKTI® (cilta-cel) received U.S. Food and Drug
Administration approval in February
2022 for the treatment of adults with relapsed or refractory
multiple myeloma after four or more prior lines of therapy,
including a proteasome inhibitor, an immunomodulatory agent, and an
anti-CD38 monoclonal antibody. In April
2024, CARVYKTI® was approved as the first and
only cell therapy in the U.S. for treatment of adult patients with
relapsed or refractory multiple myeloma who have received at least
one prior line of therapy including a proteasome inhibitor, an
immunomodulatory agent, and who are refractory to lenalidomide. In
April 2024, the European Medicines
Agency (EMA) approved a Type II variation for
CARVYKTI® for the treatment of adults with relapsed and
refractory multiple myeloma who have received at least one prior
therapy, including an immunomodulatory agent and a proteasome
inhibitor, have demonstrated disease progression on the last
therapy, and are refractory to lenalidomide.
In December 2017, Janssen Biotech,
Inc., a Johnson & Johnson company, entered into an exclusive
worldwide license and collaboration agreement with Legend Biotech
USA, Inc. to develop and
commercialize CARVYKTI®.
For more information, visit www.CARVYKTI.com.
About Multiple Myeloma
Multiple myeloma is an incurable blood cancer that affects a
type of white blood cell called plasma cells, which are found in
the bone marrow.3 In multiple myeloma, these plasma
cells proliferate and spread rapidly and replace normal cells in
the bone marrow with tumors.4 Multiple myeloma is the
third most common blood cancer worldwide and remains an incurable
disease.5 In 2024, it was estimated that more than
35,000 people will be diagnosed with multiple myeloma in the U.S.
and more than 12,000 people would die from the
disease.6 People living with multiple myeloma have
a 5-year survival rate of 59.8 percent.7 While some
people diagnosed with multiple myeloma initially have no symptoms,
most patients are diagnosed due to symptoms that can include bone
fracture or pain, low red blood cell counts, tiredness, high
calcium levels and kidney problems or infections.8,9
CARVYKTI® IMPORTANT SAFETY INFORMATION
INDICATIONS AND USAGE
CARVYKTI® (ciltacabtagene autoleucel) is a B-cell
maturation antigen (BCMA)-directed genetically modified autologous
T cell immunotherapy indicated for the treatment of adult patients
with relapsed or refractory multiple myeloma, who have received at
least 1 prior line of therapy, including a proteasome inhibitor and
an immunomodulatory agent, and are refractory to
lenalidomide.
IMPORTANT SAFETY INFORMATION
WARNING: CYTOKINE
RELEASE SYNDROME, NEUROLOGIC TOXICITIES, HLH/MAS, PROLONGED and
RECURRENT CYTOPENIA, and SECONDARY HEMATOLOGICAL
MALIGNANCIES
|
Cytokine Release
Syndrome (CRS), including fatal or life-threatening reactions,
occurred in patients following treatment with CARVYKTI®. Do not administer
CARVYKTI® to patients
with active infection or inflammatory disorders. Treat severe or
life-threatening CRS with tocilizumab or tocilizumab and
corticosteroids.
|
Immune Effector
Cell-Associated Neurotoxicity Syndrome (ICANS), which may be fatal
or life-threatening, occurred following treatment with
CARVYKTI®, including
before CRS onset, concurrently with CRS, after CRS resolution, or
in the absence of CRS. Monitor for neurologic events after
treatment with CARVYKTI®. Provide supportive care and/or
corticosteroids as needed.
|
Parkinsonism and
Guillain-Barré syndrome (GBS) and their associated complications
resulting in fatal or life-threatening reactions have occurred
following treatment with CARVYKTI®.
|
Hemophagocytic
Lymphohistiocytosis/Macrophage Activation Syndrome (HLH/MAS),
including fatal and life-threatening reactions, occurred in
patients following treatment with CARVYKTI®. HLH/MAS can occur with CRS or
neurologic toxicities.
|
Prolonged and/or
recurrent cytopenias with bleeding and infection and requirement
for stem cell transplantation for hematopoietic recovery occurred
following treatment with CARVYKTI®.
|
Secondary
hematological malignancies, including myelodysplastic syndrome and
acute myeloid leukemia, have occurred in patients following
treatment with CARVYKTI®. T-cell malignancies have
occurred following treatment of hematologic malignancies with BCMA-
and CD19-directed genetically modified autologous T-cell
immunotherapies, including CARVYKTI®.
|
CARVYKTI® is available only through a
restricted program under a Risk Evaluation and Mitigation Strategy
(REMS) called the CARVYKTI® REMS
Program.
|
WARNINGS AND PRECAUTIONS
Increased early mortality - In CARTITUDE-4, a (1:1)
randomized controlled trial, there was a numerically higher
percentage of early deaths in patients randomized to the
CARVYKTI® treatment arm compared to the control arm.
Among patients with deaths occurring within the first 10 months
from randomization, a greater proportion (29/208; 14%) occurred in
the CARVYKTI® arm compared to (25/211; 12%) in the
control arm. Of the 29 deaths that occurred in the
CARVYKTI® arm within the first 10 months of
randomization, 10 deaths occurred prior to CARVYKTI®
infusion, and 19 deaths occurred after CARVYKTI®
infusion. Of the 10 deaths that occurred prior to
CARVYKTI® infusion, all occurred due to disease
progression, and none occurred due to adverse events. Of the 19
deaths that occurred after CARVYKTI® infusion, 3
occurred due to disease progression, and 16 occurred due to adverse
events. The most common adverse events were due to infection
(n=12).
Cytokine release syndrome (CRS), including fatal or
life-threatening reactions, occurred following treatment with
CARVYKTI®. Among patients receiving CARVYKTI®
for RRMM in the CARTITUDE-1 & 4 studies (N=285), CRS occurred
in 84% (238/285), including ≥Grade 3 CRS (ASCT 2019) in 4% (11/285)
of patients. Median time to onset of CRS, any grade, was 7 days
(range: 1 to 23 days). CRS resolved in 82% with a median duration
of 4 days (range: 1 to 97 days). The most common manifestations of
CRS in all patients combined (≥10%) included fever (84%),
hypotension (29%) and aspartate aminotransferase increased (11%).
Serious events that may be associated with CRS include pyrexia,
hemophagocytic lymphohistiocytosis, respiratory failure,
disseminated intravascular coagulation, capillary leak syndrome,
and supraventricular and ventricular tachycardia. CRS occurred in
78% of patients in CARTITUDE-4 (3% Grade 3 to 4) and in 95% of
patients in CARTITUDE-1 (4% Grade 3 to 4).
Identify CRS based on clinical presentation. Evaluate for and
treat other causes of fever, hypoxia, and hypotension. CRS has been
reported to be associated with findings of HLH/MAS, and the
physiology of the syndromes may overlap. HLH/MAS is a potentially
life-threatening condition. In patients with progressive symptoms
of CRS or refractory CRS despite treatment, evaluate for evidence
of HLH/MAS.
Ensure that a minimum of two doses of tocilizumab are available
prior to infusion of CARVYKTI®.
Of the 285 patients who received CARVYKTI® in
clinical trials, 53% (150/285) patients received tocilizumab; 35%
(100/285) received a single dose, while 18% (50/285) received more
than 1 dose of tocilizumab. Overall, 14% (39/285) of patients
received at least one dose of corticosteroids for treatment of
CRS.
Monitor patients at least daily for 10 days following
CARVYKTI® infusion at a REMS-certified healthcare
facility for signs and symptoms of CRS. Monitor patients for signs
or symptoms of CRS for at least 4 weeks after infusion. At the
first sign of CRS, immediately institute treatment with supportive
care, tocilizumab, or tocilizumab and corticosteroids.
Counsel patients to seek immediate medical attention should
signs or symptoms of CRS occur at any time.
Neurologic toxicities, which may be severe,
life-threatening, or fatal, occurred following treatment with
CARVYKTI®. Neurologic toxicities included ICANS,
neurologic toxicity with signs and symptoms of parkinsonism, GBS,
immune mediated myelitis, peripheral neuropathies, and cranial
nerve palsies. Counsel patients on the signs and symptoms of these
neurologic toxicities, and on the delayed nature of onset of some
of these toxicities. Instruct patients to seek immediate medical
attention for further assessment and management if signs or
symptoms of any of these neurologic toxicities occur at any
time.
Among patients receiving CARVYKTI® in the CARTITUDE-1
& 4 studies for RRMM, one or more neurologic toxicities
occurred in 24% (69/285), including ≥Grade 3 cases in 7% (19/285)
of patients. Median time to onset was 10 days (range: 1 to 101)
with 63/69 (91%) of cases developing by 30 days. Neurologic
toxicities resolved in 72% (50/69) of patients with a median
duration to resolution of 23 days (range: 1 to 544). Of patients
developing neurotoxicity, 96% (66/69) also developed CRS. Subtypes
of neurologic toxicities included ICANS in 13%, peripheral
neuropathy in 7%, cranial nerve palsy in 7%, parkinsonism in 3%,
and immune mediated myelitis in 0.4% of the patients.
Immune Effector Cell-associated Neurotoxicity Syndrome
(ICANS): Patients receiving CARVYKTI® may
experience fatal or life-threatening ICANS following treatment with
CARVYKTI®, including before CRS onset, concurrently with
CRS, after CRS resolution, or in the absence of CRS.
Among patients receiving CARVYKTI® in the CARTITUDE-1
& 4 studies, ICANS occurred in 13% (36/285), including Grade ≥3
in 2% (6/285) of the patients. Median time to onset of ICANS was 8
days (range: 1 to 28 days). ICANS resolved in 30 of 36 (83%) of
patients with a median time to resolution of 3 days (range: 1 to
143 days). Median duration of ICANS was 6 days (range: 1 to 1229
days) in all patients including those with ongoing neurologic
events at the time of death or data cut off. Of patients with ICANS
97% (35/36) had CRS. The onset of ICANS occurred during CRS in 69%
of patients, before and after the onset of CRS in 14% of patients
respectively.
Immune Effector Cell-associated Neurotoxicity Syndrome occurred
in 7% of patients in CARTITUDE-4 (0.5% Grade 3) and in 23% of
patients in CARTITUDE-1 (3% Grade 3). The most frequent ≥2%
manifestations of ICANS included encephalopathy (12%), aphasia
(4%), headache (3%), motor dysfunction (3%), ataxia (2%) and sleep
disorder (2%).
Monitor patients at least daily for 10 days following
CARVYKTI® infusion at the REMS-certified healthcare
facility for signs and symptoms of ICANS. Rule out other causes of
ICANS symptoms. Monitor patients for signs or symptoms of ICANS for
at least 4 weeks after infusion and treat promptly. Neurologic
toxicity should be managed with supportive care and/or
corticosteroids as needed.
Parkinsonism: Neurologic toxicity with parkinsonism has
been reported in clinical trials of CARVYKTI®. Among
patients receiving CARVYKTI® in the CARTITUDE-1 & 4
studies, parkinsonism occurred in 3% (8/285), including Grade ≥ 3
in 2% (5/285) of the patients. Median time to onset of parkinsonism
was 56 days (range: 14 to 914 days). Parkinsonism resolved in 1 of
8 (13%) of patients with a median time to resolution of 523 days.
Median duration of parkinsonism was 243.5 days (range: 62 to 720
days) in all patients including those with ongoing neurologic
events at the time of death or data cut off. The onset of
parkinsonism occurred after CRS for all patients and after ICANS
for 6 patients.
Parkinsonism occurred in 1% of patients in CARTITUDE-4 (no Grade
3 to 4) and in 6% of patients in CARTITUDE-1 (4% Grade 3 to
4).
Manifestations of parkinsonism included movement disorders,
cognitive impairment, and personality changes. Monitor patients for
signs and symptoms of parkinsonism that may be delayed in onset and
managed with supportive care measures. There is limited efficacy
information with medications used for the treatment of Parkinson's
disease for the improvement or resolution of parkinsonism symptoms
following CARVYKTI® treatment.
Guillain-Barré syndrome: A fatal outcome following GBS
occurred following treatment with CARVYKTI® despite
treatment with intravenous immunoglobulins. Symptoms reported
include those consistent with Miller-Fisher variant of GBS,
encephalopathy, motor weakness, speech disturbances, and
polyradiculoneuritis.
Monitor for GBS. Evaluate patients presenting with peripheral
neuropathy for GBS. Consider treatment of GBS with supportive care
measures and in conjunction with immunoglobulins and plasma
exchange, depending on severity of GBS.
Immune mediated myelitis: Grade 3 myelitis occurred 25 days
following treatment with CARVYKTI® in CARTITUDE-4 in a
patient who received CARVYKTI® as subsequent therapy.
Symptoms reported included hypoesthesia of the lower extremities
and the lower abdomen with impaired sphincter control. Symptoms
improved with the use of corticosteroids and intravenous immune
globulin. Myelitis was ongoing at the time of death from other
cause.
Peripheral neuropathy occurred following treatment with
CARVYKTI®. Among patients receiving CARVYKTI®
in the CARTITUDE-1 & 4 studies, peripheral neuropathy occurred
in 7% (21/285), including Grade ≥3 in 1% (3/285) of the patients.
Median time to onset of peripheral neuropathy was 57 days (range: 1
to 914 days). Peripheral neuropathy resolved in 11 of 21 (52%) of
patients with a median time to resolution of 58 days (range: 1 to
215 days). Median duration of peripheral neuropathy was 149.5 days
(range: 1 to 692 days) in all patients including those with ongoing
neurologic events at the time of death or data cut off.
Peripheral neuropathies occurred in 7% of patients in
CARTITUDE-4 (0.5% Grade 3 to 4) and in 7% of patients in
CARTITUDE-1 (2% Grade 3 to 4). Monitor patients for signs and
symptoms of peripheral neuropathies. Patients who experience
peripheral neuropathy may also experience cranial nerve palsies or
GBS.
Cranial nerve palsies occurred following treatment with
CARVYKTI®. Among patients receiving CARVYKTI®
in the CARTITUDE-1 & 4 studies, cranial nerve palsies occurred
in 7% (19/285), including Grade ≥3 in 1% (1/285) of the patients.
Median time to onset of cranial nerve palsies was 21 days (range:
17 to 101 days). Cranial nerve palsies resolved in 17 of 19 (89%)
of patients with a median time to resolution of 66 days (range: 1
to 209 days). Median duration of cranial nerve palsies was 70 days
(range: 1 to 262 days) in all patients including those with ongoing
neurologic events at the time of death or data cut off. Cranial
nerve palsies occurred in 9% of patients in CARTITUDE-4 (1% Grade 3
to 4) and in 3% of patients in CARTITUDE-1 (1% Grade 3 to
4).
The most frequent cranial nerve affected was the 7th cranial
nerve. Additionally, cranial nerves III, V, and VI have been
reported to be affected.
Monitor patients for signs and symptoms of cranial nerve
palsies. Consider management with systemic corticosteroids,
depending on the severity and progression of signs and
symptoms.
Hemophagocytic Lymphohistiocytosis (HLH)/Macrophage
Activation Syndrome (MAS): Among patients receiving
CARVYKTI® in the CARTITUDE-1 & 4 studies, HLH/MAS
occurred in 1% (3/285) of patients. All events of HLH/MAS had onset
within 99 days of receiving CARVYKTI®, with a median
onset of 10 days (range: 8 to 99 days) and all occurred in the
setting of ongoing or worsening CRS. The manifestations of HLH/MAS
included hyperferritinemia, hypotension, hypoxia with diffuse
alveolar damage, coagulopathy and hemorrhage, cytopenia and
multi-organ dysfunction, including renal dysfunction and
respiratory failure.
Patients who develop HLH/MAS have an increased risk of severe
bleeding. Monitor hematologic parameters in patients with HLH/MAS
and transfuse per institutional guidelines. Fatal cases of HLH/MAS
occurred following treatment with CARVYKTI®.
HLH is a life-threatening condition with a high mortality rate
if not recognized and treated early. Treatment of HLH/MAS should be
administered per institutional standards.
CARVYKTI® REMS: Because of the risk of CRS and
neurologic toxicities, CARVYKTI® is available only
through a restricted program under a Risk Evaluation and Mitigation
Strategy (REMS) called the CARVYKTI® REMS.
Further information is available at
https://www.carvyktirems.com/ or 1-844-672-0067.
Prolonged and Recurrent Cytopenias: Patients may exhibit
prolonged and recurrent cytopenias following lymphodepleting
chemotherapy and CARVYKTI® infusion.
Among patients receiving CARVYKTI® in the CARTITUDE-1
& 4 studies, Grade 3 or higher cytopenias not resolved by day
30 following CARVYKTI® infusion occurred in 62%
(176/285) of the patients and included thrombocytopenia 33%
(94/285), neutropenia 27% (76/285), lymphopenia 24% (67/285) and
anemia 2% (6/285). After Day 60 following CARVYKTI®
infusion 22%, 20%, 5%, and 6% of patients had a recurrence of Grade
3 or 4 lymphopenia, neutropenia, thrombocytopenia, and anemia
respectively, after initial recovery of their Grade 3 or 4
cytopenia. Seventy-seven percent (219/285) of patients had one, two
or three or more recurrences of Grade 3 or 4 cytopenias after
initial recovery of Grade 3 or 4 cytopenia. Sixteen and 25 patients
had Grade 3 or 4 neutropenia and thrombocytopenia, respectively, at
the time of death.
Monitor blood counts prior to and after CARVYKTI®
infusion. Manage cytopenias with growth factors and blood product
transfusion support according to local institutional
guidelines.
Infections: CARVYKTI® should not be
administered to patients with active infection or inflammatory
disorders. Severe, life-threatening, or fatal infections, occurred
in patients after CARVYKTI® infusion.
Among patients receiving CARVYKTI® in the CARTITUDE-1
& 4 studies, infections occurred in 57% (163/285), including
≥Grade 3 in 24% (69/285) of patients. Grade 3 or 4 infections with
an unspecified pathogen occurred in 12%, viral infections in 6%,
bacterial infections in 5%, and fungal infections in 1% of
patients. Overall, 5% (13/285) of patients had Grade 5 infections,
2.5% of which were due to COVID-19. Patients treated with
CARVYKTI® had an increased rate of fatal COVID-19
infections compared to the standard therapy arm.
Monitor patients for signs and symptoms of infection before and
after CARVYKTI® infusion and treat patients
appropriately. Administer prophylactic, pre-emptive and/or
therapeutic antimicrobials according to the standard institutional
guidelines. Febrile neutropenia was observed in 5% of patients
after CARVYKTI® infusion and may be concurrent with CRS.
In the event of febrile neutropenia, evaluate for infection and
manage with broad-spectrum antibiotics, fluids and other supportive
care, as medically indicated. Counsel patients on the importance of
prevention measures. Follow institutional guidelines for the
vaccination and management of immunocompromised patients with
COVID-19.
Viral Reactivation: Hepatitis B virus (HBV) reactivation,
in some cases resulting in fulminant hepatitis, hepatic failure and
death, can occur in patients with hypogammaglobulinemia. Perform
screening for Cytomegalovirus (CMV), HBV, hepatitis C virus (HCV),
and human immunodeficiency virus (HIV) or any other infectious
agents if clinically indicated in accordance with clinical
guidelines before collection of cells for manufacturing. Consider
antiviral therapy to prevent viral reactivation per local
institutional guidelines/clinical practice.
Hypogammaglobulinemia: can occur in patients receiving
treatment with CARVYKTI®. Among patients receiving
CARVYKTI® in the CARTITUDE-1 & 4 studies,
hypogammaglobulinemia adverse event was reported in 36% (102/285)
of patients; laboratory IgG levels fell below 500mg/dl after
infusion in 93% (265/285) of patients. Hypogammaglobulinemia either
as an adverse reaction or laboratory IgG level below 500mg/dl,
after infusion occurred in 94% (267/285) of patients treated. Fifty
six percent (161/285) of patients received intravenous
immunoglobulin (IVIG) post CARVYKTI® for either an
adverse reaction or prophylaxis.
Monitor immunoglobulin levels after treatment with
CARVYKTI® and administer IVIG for IgG <400 mg/dL.
Manage per local institutional guidelines, including infection
precautions and antibiotic or antiviral prophylaxis.
Use of Live Vaccines: The safety of immunization with live
viral vaccines during or following CARVYKTI® treatment
has not been studied. Vaccination with live virus vaccines is not
recommended for at least 6 weeks prior to the start of
lymphodepleting chemotherapy, during CARVYKTI®
treatment, and until immune recovery following treatment with
CARVYKTI®.
Hypersensitivity Reactions occurred following treatment
with CARVYKTI®. Among patients receiving
CARVYKTI® in the CARTITUDE-1 & 4 studies,
hypersensitivity reactions occurred in 5% (13/285), all of which
were ≤Grade 2. Manifestations of hypersensitivity reactions
included flushing, chest discomfort, tachycardia, wheezing, tremor,
burning sensation, non-cardiac chest pain, and pyrexia.
Serious hypersensitivity reactions, including anaphylaxis, may
be due to the dimethyl sulfoxide (DMSO) in CARVYKTI®.
Patients should be carefully monitored for 2 hours after infusion
for signs and symptoms of severe reaction. Treat promptly and
manage patients appropriately according to the severity of the
hypersensitivity reaction.
Secondary Malignancies: Patients treated with
CARVYKTI® may develop secondary malignancies. Among
patients receiving CARVYKTI® in the CARTITUDE-1 & 4
studies, myeloid neoplasms occurred in 5% (13/285) of patients (9
cases of myelodysplastic syndrome, 3 cases of acute myeloid
leukemia, and 1 case of myelodysplastic syndrome followed by acute
myeloid leukemia). The median time to onset of myeloid neoplasms
was 447 days (range: 56 to 870 days) after treatment with
CARVYKTI®. Ten of these 13 patients died following the
development of myeloid neoplasms; 2 of the 13 cases of myeloid
neoplasm occurred after initiation of subsequent antimyeloma
therapy. Cases of myelodysplastic syndrome and acute myeloid
leukemia have also been reported in the post marketing setting.
T-cell malignancies have occurred following treatment of
hematologic malignancies with BCMA- and CD19-directed genetically
modified autologous T-cell immunotherapies, including
CARVYKTI®. Mature T-cell malignancies, including
CAR-positive tumors, may present as soon as weeks following
infusions, and may include fatal outcomes.
Monitor life-long for secondary malignancies. In the event that
a secondary malignancy occurs, contact Janssen Biotech, Inc. at
1-800-526-7736 for reporting and to obtain instructions on
collection of patient samples.
Effects on Ability to Drive and Use Machines: Due to the
potential for neurologic events, including altered mental status,
seizures, neurocognitive decline or neuropathy, patients receiving
CARVYKTI® are at risk for altered or decreased
consciousness or coordination in the 8 weeks following
CARVYKTI® 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, and in the event of new onset of any neurologic
toxicities.
ADVERSE REACTIONS
The most common nonlaboratory adverse reactions (incidence
greater than 20%) are pyrexia, cytokine release syndrome,
hypogammaglobulinemia, hypotension, musculoskeletal pain, fatigue,
infections-pathogen unspecified, cough, chills, diarrhea, nausea,
encephalopathy, decreased appetite, upper respiratory tract
infection, headache, tachycardia, dizziness, dyspnea, edema, viral
infections, coagulopathy, constipation, and vomiting. The most
common Grade 3 or 4 laboratory adverse reactions (incidence greater
than or equal to 50%) include lymphopenia, neutropenia, white
blood cell decreased, thrombocytopenia, and anemia.
Please read full Prescribing Information, including Boxed
Warning, for CARVYKTI®.
About Johnson & Johnson
At Johnson & Johnson, we believe health is everything. Our
strength in healthcare innovation empowers us to build a world
where complex diseases are prevented, treated, and cured, where
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This press release contains "forward-looking statements" as
defined in the Private Securities Litigation Reform Act of 1995
regarding product development and the potential benefits and
treatment impact of
CARVYKTI® (ciltacabtagene
autoleucel; cilta-cel). The reader is cautioned not to rely on
these forward-looking statements. These statements are based on
current expectations of future events. If underlying assumptions
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Form 10-K for the fiscal year ended December
31, 2023, including in the sections captioned "Cautionary
Note Regarding Forward-Looking Statements" and "Item 1A. Risk
Factors," and in Johnson & Johnson's subsequent Quarterly
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request from Johnson & Johnson. None of Janssen Research &
Development, LLC, Janssen Biotech, Inc., Janssen Global Services,
LLC nor Johnson & Johnson undertake to update any
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* Dr Rakesh Popat, University College
London Hospitals, NHS Foundation Trust, London, UK, has provided consulting, advisory,
and speaking services to Johnson & Johnson; he has not been
paid for any media work.
1 Popat R, et al. Ciltacabtagene Autoleucel
(Cilta-cel) vs Standard of Care (SoC) in Patients With Lenalidomide
(Len)-Refractory Multiple Myeloma (MM) After 1–3 Lines of Therapy:
Minimal Residual Disease (MRD) Negativity in the Phase 3
CARTITUDE-4 Trial. American Society of Hematology 2024 Annual
Meeting. December 2024.
2 Bar N, et al. Long-Term Benefits in Patient-Reported
Outcomes and Time to Next Anti-Myeloma Therapy of Ciltacabtagene
autoleucel (Cilta-cel) versus Standard of Care for Patients with
Lenalidomide-Refractory Multiple Myeloma: Results from the Phase 3
CARTITUDE-4 Clinical Trial. American Society of Hematology 2024
Annual Meeting. December 2024.
3 Rajkumar SV. Multiple myeloma: 2020 update on
diagnosis, risk-stratification and management. Am J
Hematol. 2020;95(5):548-567.
4 National Cancer Institute. Plasma Cell Neoplasms.
https://www.cancer.gov/types/myeloma/patient/myeloma-treatment-pdq.
Accessed December 2024.
5 City of Hope. Multiple Myeloma: Causes, Symptoms
& Treatments.
https://www.cancercenter.com/cancer-types/multiple-myeloma.
Accessed December 2024.
6 American Cancer Society. Key Statistics About
Multiple
Myeloma. https://www.cancer.org/cancer/multiple-myeloma/about/key-statistics.html#:~:text=Multiple%20myeloma%20is%20a%20relatively,men%20and%2015%2C370%20in%20women.
Accessed December 2024.
7 SEER Explorer: An interactive website for SEER
cancer statistics [Internet]. Surveillance Research Program,
National Cancer Institute. https://seer.cancer.gov/explorer/.
Accessed December 2024.
8 American Cancer Society. What is Multiple
Myeloma?
https://www.cancer.org/cancer/multiple-myeloma/about/what-is-multiple-myeloma.html.
Accessed December 2024.
9 American Cancer Society. Multiple Myeloma Early
Detection, Diagnosis, and Staging.
https://www.cancer.org/cancer/types/multiple-myeloma/detection-diagnosis-staging/detection.html.
Accessed December 2024.
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