Common brand names

• Tecartus

How it is administered

Brexucabtagene autoleucel is given as a single intravenous (IV) infusion. The medication is prepared specifically for each patient using their own T cells, which are collected from the blood through a process called leukapheresis. These cells are then genetically modified and expanded in a laboratory before being infused back into the patient.

Before the infusion, patients receive a short course of chemotherapy (lymphodepleting regimen) to prepare their body for the treatment. The infusion is done in a hospital or specialized treatment center, and patients are closely monitored during and after the procedure.

How it works

Brexucabtagene autoleucel is a type of CAR T-cell therapy. It works by using the patient’s own immune cells (T cells), which are collected and then genetically engineered in the laboratory to recognize and attack cancer cells that express the CD19 protein. This is done by introducing a new gene into the T cells that allows them to produce a special receptor called a chimeric antigen receptor (CAR). This CAR targets the CD19 protein found on the surface of certain blood cancer cells, such as those in mantle cell lymphoma (MCL) and B-cell precursor acute lymphoblastic leukemia (ALL).

Once these modified T cells are infused back into the patient, they can find, bind to, and kill the cancer cells. The therapy also leads to the release of immune signaling molecules (cytokines), which help coordinate the immune response. This targeted approach allows for the destruction of cancerous B cells while sparing most other cells.

Who should take it

Brexucabtagene autoleucel is indicated for adult patients with relapsed or refractory mantle cell lymphoma (MCL) and for adult patients with relapsed or refractory B-cell precursor acute lymphoblastic leukemia (ALL). This means it is used when these cancers have not responded to previous treatments or have come back after treatment.

Patients who have already tried standard therapies, such as chemotherapy, anti-CD20 antibodies, and Bruton tyrosine kinase inhibitors (for MCL), and whose disease continues to progress, may be considered for this therapy. It is typically reserved for patients with few other treatment options.

Who should not take it

There are no absolute contraindications listed for brexucabtagene autoleucel, but it should not be given to patients with clinically significant active systemic infections. Patients should also not receive this therapy if they have active or serious infections, or if they are pregnant, as the effects on pregnancy are unknown and may be harmful to the fetus.

Patients with certain central nervous system disorders or active graft-vs-host disease may not be eligible. The therapy is not approved for use in pediatric patients, as safety and effectiveness have not been established in children.

Commonly used with

Brexucabtagene autoleucel is used after a lymphodepleting chemotherapy regimen, which typically includes cyclophosphamide and fludarabine. These medications are given before the CAR T-cell infusion to help the new cells work better.

During and after treatment, supportive medications such as acetaminophen and diphenhydramine may be used to reduce infusion-related reactions. In case of severe side effects like cytokine release syndrome, medications such as tocilizumab (an anti-IL-6 receptor antibody) and corticosteroids may be used.

Commonly tested with

Brexucabtagene autoleucel has been tested in combination with lymphodepleting chemotherapy agents, specifically cyclophosphamide and fludarabine, as part of the standard treatment protocol.

In clinical trials and real-world use, supportive therapies such as tocilizumab and corticosteroids are often used to manage side effects like cytokine release syndrome and neurologic toxicities.