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Afamitresgene Autoleucel

FDA Drug Information • Also known as: Tecelra

Brand Names
Tecelra
Route
INTRAVENOUS
Dosage Form
INJECTION, SUSPENSION
Product Type
CELLULAR THERAPY

⚠ Boxed Warning (Black Box)

WARNING: CYTOKINE RELEASE SYNDROME Cytokine Release Syndrome (CRS), which may be severe or life-threatening, occurred in patients receiving TECELRA. At the first sign of CRS, immediately evaluate patient for hospitalization and institute treatment with supportive care. Ensure that healthcare providers administering TECELRA have immediate access to medications and resuscitative equipment to manage CRS [see Preparation and Administration ( 2.2 ), and Warnings and Precautions ( 5.1 )] . WARNING: CYTOKINE RELEASE SYNDROME See full prescribing information for complete boxed warning. Cytokine Release Syndrome (CRS), which may be severe or life-threatening, occurred in patients receiving TECELRA. At the first sign of CRS, immediately evaluate patient for hospitalization and institute treatment with supportive care. Ensure that healthcare providers administering TECELRA have immediate access to medications and resuscitative equipment to manage CRS ( 2.2 , 5.1 ).

Description

11 DESCRIPTION TECELRA (afamitresgene autoleucel) is a melanoma-associated antigen A4 (MAGE- A4)-directed genetically modified autologous T cell immunotherapy product consisting of CD4 and CD8 positive T cells transduced with a self-inactivating lentiviral vector (LV) expressing an affinity-enhanced T cell receptor (TCR) specific for the human MAGE-A4. Autologous T cells transduced with MAGE-A4-c1032 LV express the affinity-enhanced TCR on the cell surface. The TCR recognizes an HLA-A*02 restricted MAGE-A4 peptide. MAGE-A4 is an intracellular cancer-testis antigen that has restricted expression in normal tissues and is expressed in synovial sarcoma. TECELRA is prepared from the patient's peripheral blood mononuclear cells (PBMCs), which are obtained via a standard leukapheresis procedure. The PBMCs are enriched for T cells and are then transduced with a replication-incompetent LV containing the MAGE-A4 TCR transgene. The transduced T cells are expanded, washed, formulated into a suspension, and cryopreserved. The product must pass a sterility test before release and shipping as a frozen suspension in one or more infusion bag(s). The product is thawed prior to infusion back into the patient [see Preparation and Administration ( 2.2 ), How Supplied/Storage and Handling ( 16 )]. The drug product formulation contains 5% dimethyl sulfoxide (DMSO).

What Is Afamitresgene Autoleucel Used For?

1 INDICATIONS AND USAGE TECELRA is a melanoma-associated antigen A4-(MAGE-A4)-directed genetically modified autologous T cell immunotherapy indicated for the treatment of adults with unresectable or metastatic synovial sarcoma who have received prior chemotherapy, are HLA-A*02:01P, -A*02:02P, -A*02:03P, or -A*02:06P positive and whose tumor expresses the MAGE-A4 antigen as determined by FDA-approved or cleared companion diagnostic devices. This indication is approved under accelerated approval based on overall response rate and durability of response [see Clinical Studies ( 14 )]. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial. TECELRA is a melanoma-associated antigen A4 (MAGE-A4)-directed genetically modified autologous T cell immunotherapy indicated for the treatment of adults with unresectable or metastatic synovial sarcoma who have received prior chemotherapy, are HLA-A*02:01P, -A*02:02P, -A*02:03P, or -A*02:06P positive and whose tumor expresses the MAGE-A4 antigen as determined by FDA-approved or cleared companion diagnostic devices. This indication is approved under accelerated approval based on overall response rate and duration of response ( 14 ). Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial.

Dosage and Administration

2 DOSAGE AND ADMINISTRATION For autologous use only. For intravenous use only. For autologous use only. For intravenous use only. Prior to infusion Verify patient's identity prior to infusion ( 2.2 ). Administer a lymphodepleting regimen of cyclophosphamide and fludarabine ( 2.2 ). Premedicate with acetaminophen and an H1-antihistamine ( 2.2 ). TECELRA Dose and Administration The recommended dose is between 2.68 x 10 9 to 10 x 10 9 MAGE-A4 T cell receptor (TCR) positive T cells ( 2.1 ). Administer each infusion bag within one hour of thawing. DO NOT USE a leukodepleting filter ( 2.2 ). DO NOT USE prophylactic systemic corticosteroids ( 2.2 ). 2.1 Recommended Dose The recommended dose is between 2.68 x 10 9 to 10 x 10 9 MAGE-A4 T cell receptor (TCR) positive T cells administered as a single intravenous infusion. TECELRA is provided as a single dose for infusion in one or more infusion bag(s). Verify the number of bags received for the indicated dose prior to preparation for infusion. 2.2 Preparation and Administration Receipt of TECELRA Plan for TECELRA to arrive prior to beginning lymphodepleting chemotherapy. Ensure storage conditions in vapor phase of liquid nitrogen (≤ -130°C). TECELRA is shipped directly to the healthcare facility in the vapor phase of a liquid nitrogen shipper. Upon receipt of TECELRA confirm the patient's identifiers on the metal cassette and product bag. Inspect the product for obvious signs of damage and contact 1-855-246-9232 if any anomalies are identified at the time of receipt. Transfer TECELRA in the original packaging, containing the cassette(s) protecting the infusion bag(s), to onsite storage at ≤ -130°C before the shipper expires. Store TECELRA in a manner that is consistent with How Supplied/Storage and Handling ( 16 ) . If unforeseen circumstances prevent proper storage of TECELRA consistent with How Supplied/Storage and Handling ( 16 ) , contact 1-855-246-9232 to arrange for return shipment. Preparing Patient for TECELRA Administration Confirm availability of TECELRA at the healthcare facility prior to starting the lymphodepleting chemotherapy regimen. Match the patient's identity with the patient identifiers on the TECELRA cassette(s) and infusion bag(s). Do not infuse TECELRA if the information on the patient-specific label(s) does not match the intended patient. Administer a lymphodepleting chemotherapy regimen of fludarabine 30 mg/m 2 /day intravenously for 4 days starting on the seventh day before TECELRA infusion (Day-7 to Day -4) and cyclophosphamide 600 mg/m 2 /day intravenously for 3 days starting the seventh day before TECELRA infusion (Day -7 to Day -5). Refer to fludarabine prescribing for information on fludarabine dosage in patients with renal impairment. Short-acting or pegylated granulocyte-colony stimulating factor (G-CSF) may be administered at the discretion of the physician, and according with institutional standards, from 24 hours after last day of lymphodepleting chemotherapy (from Day...

Side Effects (Adverse Reactions)

6 ADVERSE REACTIONS Most common adverse reactions (≥ 20%) were, cytokine release syndrome, nausea, vomiting, fatigue, infections, pyrexia, constipation, dyspnea, abdominal pain, non-cardiac chest pain, decreased appetite, tachycardia, back pain, hypotension, diarrhea, and edema. Grade 3 or 4 laboratory abnormalities (≥20%) were lymphocyte count decreased, neutrophil count decreased, white cell blood count decreased, red blood cell decreased, and platelet count decreased ( 6.1 ). The most common serious adverse reactions (≥ 5%) were cytokine release syndrome and pleural effusion ( 6.1 ). To report SUSPECTED ADVERSE REACTIONS, contact USWM CT, LLC at 1-855-246-9232 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. The safety data described in this section reflects the exposure to TECELRA in 44 patients with advanced synovial sarcoma treated in the SPEARHEAD-1 clinical trial (Cohort 1). Patients with synovial sarcoma received TECELRA across a dose of 2.68 x 10 9 to 10 x 10 9 MAGE-A4 TCR positive T cells [see Clinical Studies ( 14 )]. Serious adverse reactions occurred in 52% of patients with synovial sarcoma. The most common serious adverse reactions (occurring in ≥ 5%) included CRS (9%) and pleural effusion (7%). Table 1 summarizes adverse reactions that occurred in at least 10% of patients. Table 1. Adverse Reactions Occurring in ≥10% of Patients in SPEARHEAD-1 (Cohort 1) SOC Grouped Term (N=44) All Grades n (%) Grade ≥ 3 n (%) Investigations Weight decreased 5 (11) 1 (2) Gastrointestinal disorders Nausea 29 (66) 1 (2) Vomiting 16 (36) 0 (0) Constipation 14 (32) 0 (0) Abdominal pain 11 (25) 2 (5) Diarrhea 9 (21) 0 (0) General disorders and administration site conditions Fatigue 15 (34) 0 (0) Pyrexia 14 (32) 2 (5) Non-cardiac chest pain 10 (23) 1 (2) Chills 7 (16) 0 (0) Edema 9 (21) 0 (0) Asthenia 7 (16) 1 (2) Chest pain 6 (14) 0 (0) Immune system disorders Cytokine Release Syndrome As per American Society for Transplantation and Cellular Therapy (ASTCT) criteria 1 33 (75) 1 (2) Infections and infestations Any infection Any infection includes all infection terms under the 'Infections and infestations' System Organ Class 14 (32) 6 (14) Nervous system disorders Headache 8 (18) 1 (2) Dizziness 5 (11) 0 (0) Metabolism and nutrition disorders Decreased appetite 10 (23) 1 (2) Musculoskeletal and connective tissue disorders Back pain 9 (21) 2 (5) Pain in extremity 6 (14) 0 (0) Respiratory, thoracic, and mediastinal disorders Dyspnea 11 (25) 2 (5) Cough 8 (18) 0 (0) Vascular disorders Hypotension 9 (21) 0 (0) Hypertension 7 (16) 1 (2) Cardiac disorders Sinus Tachycardia/ Tachycardia 9 (21) 0 (0) Skin and subcutaneous tissue disorders Alopecia 6 (14) 0 (0) Other clinically important adverse reactions occurring in patients receiving TECELRA include Grade 1 ICANS reported in one patient (2%). Table 2. Laboratory Abnormalities Abnormalities are laboratory values that were considered an adverse event Worsened from Baseline in ≥10% of Patients in SPEARHEAD-1 (Cohort 1) Laboratory Abnormalities N=44 All Grades n (%) Grade 3 or 4 n (%) Grading based on NCI CTCAE version 5.0. Lymphocyte count decreased 43 (98) 43 (98) Neutrophil count decreased 42 (96) 40 (91) White blood cell decreased 42 (96) 38 (86) Red blood cell decreased 42 (96) 14 (32) Platelet count decreased 36 (82) 9 (21) Alanine aminotransferase increased 20 (46) 2 (5)

Drug Interactions

7 DRUG INTERACTIONS None

Contraindications

4 CONTRAINDICATIONS DO NOT use TECELRA in adults who are heterozygous or homozygous for HLA- A*02:05P. DO NOT use TECELRA in adults who are heterozygous or homozygous for HLA-A*02:05P ( 4 ).

Pregnancy and Breastfeeding

8.1 Pregnancy Risk Summary There are no available data with TECELRA use in pregnant women. No animal reproductive and developmental toxicity studies have been conducted with TECELRA to assess whether it can cause fetal harm when administered to a pregnant woman. It is not known if TECELRA has the potential to be transferred to the fetus and cause fetal toxicity. Therefore, TECELRA is not recommended for women who are pregnant, and pregnancy after TECELRA administration should be discussed with the treating physician. Report all pregnancies following treatment with TECELRA to 1-855-246-9232. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively.

How Supplied

16 HOW SUPPLIED/STORAGE AND HANDLING TECELRA is supplied in one or more infusion bag(s) containing a frozen suspension of genetically modified autologous T cells in 5% DMSO. Each TECELRA infusion bag is individually packed in a metal cassette. Product and patient-specific labels are located on both the product infusion bag(s) and the protective shipping cassette(s). Each infusion bag (250ml) is contained within a protective metal cassette (NDC 87262-160-02). TECELRA is shipped in a liquid nitrogen dry vapor shipper at less than or equal to -130°C. Store TECELRA in the original packaging, containing the cassette(s) protecting the infusion bag(s), in the vapor phase of liquid nitrogen at less than or equal to -130°C.

About This Information

This drug information is sourced from FDA-approved labeling via the openFDA database. It is intended for educational and reference purposes only. This is not medical advice. Always consult your healthcare provider before making decisions about medication. Drug information may be updated by the FDA; check with your pharmacist for the most current information.

What are side effects?

Side effects are unwanted reactions that can occur when taking a medication. They range from mild (headache, nausea) to severe (allergic reactions, organ damage). Not everyone experiences side effects, and severity varies. Report any concerning side effects to your doctor.

What are drug interactions?

Drug interactions occur when a medication is affected by another drug, food, or supplement. Interactions can make medications less effective or cause dangerous side effects. Always tell your doctor about all medications and supplements you take.