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The pairing of two Bristol Myers Squibb immunotherapies is now permitted for the first-line treatment of two types of gastrointestinal cancers, after regulatory decisions handed out this past week that convert the accelerated approval status of the drug combination to full FDA approval in both indications. The drugs, Opdivo and Yervoy, belong to the class of medicines called checkpoint inhibitors. On April 8, the FDA approved use of this drug combination for adults and children age 12 and older whose colorectal cancer has metastasized or cannot be removed by surgery. The cancer must also be microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR), references to biomarkers that indicate the stability of DNA in a tumor. The regulatory submission was based on the results of an open-label Phase 3 test that compared the Opdivo/Yervoy combination to either Opdivo alone or chemotherapy. Results showed the immunotherapy combination led to a 38% reduction in the risk of disease progression or death compared to Opdivo monotherapy, and by 79% compared to chemo, both in the first-line setting. The study is ongoing to assess secondary measures, including overall survival. BMS said it will continue working with study investigators to present these data and longer-term follow-up results in the future. Sponsored Post Changes in Nurse Staffing Answer Clinician Demands The ongoing nursing shortage facilitates high turnover rates since nurses know they won’t have difficulties finding new jobs. In order to retain and attract staff, it’s in a facility’s best interest to understand what nurses want. By Tomasz Rezik On April 11, the FDA approved the combination of Opdivo and Yervoy for treating advanced cases of hepatocellular carcinoma. In the pivotal test in this indication, the drug combination led to median overall survival of 23.7 months. The comparator arm, in which patients received standard of care drugs sorafenib or levantinib, median overall survival was 20.6 months. At three years, the drug combination showed an overall survival rate of 38% versus 24% in the comparator arm. FDA approval of Opdivo plus Yervoy in hepatocellular carcinoma follows the European Commission’s early March approval of the drug combination in this indication. There’s plenty of news on the regulatory front. Here’s a recap of other recent highlights: New and Expanded Regulatory Approvals —Argenx drug Vyvgart Hytrulo received an additional approval for dosing of the product via a prefilled syringe. The drug, supplied in vials, previously received FDA approvals for the autoimmune conditions chronic inflammatory demyelinating polyneuropathy and generalized myasthenia gravis. Analysts say prefilled syringes bring patients a more convenient dosing option while giving Argenx the opportunity to get more market share by penetrating into earlier lines of therapy. Sponsored Post Understanding EGPA: The Role of Eosinophils and Advancements in Treatment Options FASENRA® (benralizumab) injection, for subcutaneous use, 30 mg is indicated for the treatment of adult patients with eosinophilic granulomatosis with polyangiitis (EGPA). FASENRA provides a treatment option for HCPs to consider when managing this challenging disease. By FASENRA, Sponsored Content —Amgen’s Uplizna expanded its label to include the treatment of immunoglobulin G4-related disease (IgG4-RD), an immune-mediated inflammatory disorder that can affect multiple organs. The regulatory decision makes the intravenously infused antibody the first FDA-approved treatment for this rare and chronic disease. Uplizna was first approved in 2020 as a treatment for neuromyelitis optica spectrum disorder. —Bayer’s Viktrakvi now has full FDA approval for the treatment of NTRK gene fusion-positive solid tumors in adults and children without a known acquired resistance mutation. The drug received accelerated approval in this indication in 2018. —AstraZeneca and Daiichi Sankyo welcomed European Union approval of Datroway as a treatment for metastatic breast cancer that is HR positive and HER2 negative. Datroway received FDA approval in the same indication in January. The drug is an antibody drug conjugate designed to target the cancer protein TROP2. —Novartis drug atrasentan, brand name Vanrafia, was awarded accelerated approval as a new treatment for the kidney disorder immunoglobulin A nephropathy (IgAN). The drug is an oral small molecule designed to block the endothelin A receptor. It’s one of two IgAN nephropathy drugs that came via the $3.2 billion acquisition of Chinook Therapeutics in 2023. Novartis’s internal IgAN research yielded the complement inhibitor Fabhalta, which received accelerated approval in this indication last summer. —Speaking of Fabhalta, that Novartis drug expanded its label to include C3 glomerulopathy, making the twice-daily pill the first approved treatment for this rare kidney disorder. Fabhalta is a small molecule designed to block the complement protein C3. It was first approved in 2023 as a treatment for the rare blood disorder paroxysmal nocturnal hemoglobinuria. —Sanofi received FDA approval for fitusiran, brand name Qfitlia, as a treatment for both hemophilia A and B. The drug leverages RNA interference to lower levels of AT, a protein that inhibits blood clotting. The approval covers the treatment of adults and children age 12 and older with or without inhibitors, which are antibodies that can develop in hemophilia patients, making it more difficult to control bleeding. By contrast, new Pfizer drug Hympavzi is approved only for hemophilia A and B patients without inhibitors while Sanofi’s Alhemo is approved only for hemophilia A and B patients with inhibitors. —Blockbuster AstraZeneca cancer immunotherapy Imfinzi landed European Union approval for the treatment of limited-stage small cell lung cancer. This new approval is based on Phase 3 results showing a 27% reduction in the risk of death compared to a placebo. The FDA approved Imfinzi for this indication last December. —Imfinzi also added perioperative treatment of muscle invasive bladder cancer to its list of FDA-approved indications. The newest FDA nod covers use of the drug in combination with chemotherapy before surgery to remove the bladder, followed by Imfinzi as an adjuvant monotherapy. In the pivotal study supporting this new indication, results showed a 32% reduction in the risk of cancer recurrence and a 25% reduction in the risk of death compared to neoadjuvant chemotherapy alone. —The European Commission approved Pfizer vaccine Abrysvo for protection against respiratory syncytial virus (RSV). The regulatory decision expands the vaccine’s approval to adults ages 18 to 59. European regulators initially approved the vaccine in 2023 for preventing lower respiratory tract disease in adults age 60 and older. Abrysvo won FDA approval the same year. —The FDA expanded approval of Novartis’s Pluvicto to include use as an earlier line of treatment — after anti-androgen drugs and before chemotherapy — for PSMA-positive metastatic castration-resistant prostate cancer (mCRPC). Pluvicto was initially approved in 2022 for PSMA-positive mCRPC that has already been treated with an anti-androgen drug and chemotherapy. Novartis said this expansion is important because about half of patients do not live long enough to receive a second-line treatment. —Exelixis cancer drug Cabometyx expanded its FDA-approved uses to advanced cases of pancreatic neuroendocrine tumors (pNET) and extra-pancreatic neuroendocrine tumors (epNET). The approval covers adults and children age 12 and older. Cabometyx is a small molecule designed to block enzymes that support cancer growth. The drug was first approved in 2016 for advanced renal cell carcinoma. —GSK landed FDA approval for Blujepa, an oral antibiotic developed to treat uncomplicated urinary tract infections. While drugs are already available for these infections, they can become resistant to treatment. Blujepa is designed to block two enzyme targets key to bacterial DNA replication, an approach intended to lower the potential for drug resistance. —The European Commission approved Capvaxive, a pneumococcal vaccine developed by Merck to protect against the 21 Streptococcus pneumoniae serotypes that lead to the majority of cases of invasive pneumococcal disease including eight that are not covered by any other available pneumococcal vaccine. The European regulatory decision covers adults age 18 and older. Capvaxive received FDA approval last July. —Alynlam Pharmaceuticals drug Amvuttra received FDA approval for treating cardiomyopathy caused by transthyretin amyloidosis (ATTR). The RNA interference drug was first approved in 2022 for the treatment of polyneuropathy caused by ATTR. In the cardiomyopathy indication, it will compete with Pfizer’s Vyndaqel and Vyndamax, which are established as the standard of care, as well as Attruby, a BridgeBio Pharma drug that received FDA approval last fall. —Bristol Myers Squibb’s Breyanzi received European Commission approval for relapsed or refractory follicular lymphoma. The CAR T-therapy received accelerated FDA approval in this indication last May. —Geron Corporation’s Rytelo received European Commission approval for the treatment of transfusion-dependent anemia caused by lower-risk myelodysplastic syndrome, a progressive type of blood cancer. The intravenously infused drug is the first telomerase inhibitor to reach the market. Rytelo landed FDA approval last June. —Neffy, an epinephrine nasal spray that ARS Pharmaceuticals developed to treat allergic reactions to insect bites, medications, and food, expanded its FDA approval to include patients weighing 15 to 30 kilograms (about 33 to 60 pounds). The product’s initial approval last year covered its use in patients weighing 30 kg or more. —Roche subsidiary Genentech received FDA approval for tenecteplase, brand name TNKase, as a treatment for acute ischemic stroke in adults. Genentech said TNKase is the first stroke medicine approved by the FDA in nearly 30 years. It’s the second approved indication for the clot-busting drug. The FDA approved it in 2000 for treating acute myocardial infarction. —A Neurotech Pharmaceuticals cell and gene therapy administered via a surgical implant received FDA approval for the treatment of macular telangectasia type 2. The therapy, brand name Encelto, is the first approved treatment for this rare vision-loss disorder. Regulatory Setbacks —The FDA missed the April 1 regulatory decision target date for Novavax’s Covid-19 vaccine. Politico reported the holdup was due to the intervention of Sara Brenner, the FDA’s principal deputy commissioner, who asked for more data. Novavax said it has responded to all of the FDA’s information requests and believes the application is ready for approval based on the submitted Phase 3 data. Novavax’s protein-based vaccine initially received FDA emergency use authorization in 2022, a status that it retained under amended authorizations in 2023 and last year, both times for new formulas that covered the prevalent variants at the time. Full FDA approval would put the vaccine on par with the approved messenger RNA vaccines marketed by Pfizer and Moderna. Novavax’s Covid-19 vaccine will be co-commercialized with Sanofi under a partnership announced last year. —Roche paused European clinical tests of the Duchenne muscular dystrophy gene therapy Elevidys, the pharmaceutical giant said in a letter to the World Duchenne Organization. The move follows Sarepta Therapeutics’ recent report of a liver failure-associated patient death. Roche said the European Medicines Agency asked for a clinical hold on four studies until the inquiry into the cause of death is complete. Under a 2019 deal with Sarepta, Roche holds rights to Elevidys outside of the U.S. —For the second time, the FDA has rejected Aldeyra Therapeutics drug reproxalap as a treatment for dry eye disease. The agency turned down an application for the drug in 2023. According to Aldeyra, the FDA’s latest complete response letter said the new drug application failed to demonstrate efficacy. The regulator asked the company to run at least one more clinical trial. Among the concerns raised by the FDA is differences in baseline scores, which may have affected interpretation of trial results. Aldeyra said results from two ongoing studies are expected later in the current quarter, potentially paving the way for a mid-year resubmission of the application. —The European Medicines Agency refused marketing authorization for Eli Lilly Alzheimer’s disease drug Kisunla. Safety was the main reason cited, particularly the brain inflammation and bleeding that is a known complication risk associated with all drugs in the same class of Alzheimer’s medicines. The agency said the drug’s benefits were not enough to outweigh the potentially fatal safety risks. The FDA approved Kisunla last July. —In other Alzheimer’s drug news, Eisai again failed to persuade Australia’s drugs regulator to register Leqembi. The pharma company had asked the Therapeutics Goods Administration (TGA) to reconsider its October 2024 decision to not register the drug in Australia. Eisai’s request for reconsideration covered a narrower indication, but Eisai said the TGA did not agree that safety has been established for these patients.

iStock/ Jian Fan Having established success in cancer, biopharma is now looking to leverage CAR T therapies against a new target, autoimmune disorders, with several early- to mid-stage readouts expected this year. In September 2022, an intriguing report went up on Nature Medicine. Though the study was small, its impact on biopharma has been huge. The study enrolled five patients with systemic lupus erythematosus (SLE), a chronic autoimmune condition where the immune system targets the patient’s own body. SLE triggers inflammation in organs across the body and can manifest as a wide variety of symptoms, including fevers, blood clots, swollen extremities, fatigue and mouth sores. There is currently no cure for SLE, but the Nature Medicine paper sparked hope that one might be near. The study tested a relatively new technology called CAR T cell therapy, which often uses a patient’s own immune T cells, modifying them outside of the body to make them more potent against certain target cells and then injecting them back into the patient. This approach has already seen success in cancer, with several therapies having earned the FDA’s approval: Gilead’s Yescarta, Johnson & Johnson’s Carvykti and Novartis’ Kymriah, to name a few. The Nature Medicine study hinted at similar promise in autoimmune diseases—all five treated patients hit and maintained remission for an average of eight months and no longer needed other treatments to keep SLE at bay. Two years later, the New England Journal of Medicine published a slightly larger study —including 15 patients—that confirmed these findings and pointed to even broader benefits. CAR T therapy not only elicited remission in SLE patients but also resulted in encouraging response rates in those with idiopathic inflammatory myositis or systemic sclerosis. “Cell therapies are the only modality that appear to provide a prolonged period of drug-free remission, which can be transformative for [a] patient’s quality of life,” Sami Corwin, an analyst at William Blair, told BioSpace in an email. The CAR T approach, in particular, offers a one-time treatment option and is “not associated with chronic side-effects,” as compared with other modalities, Corwin added. Though T cell engagers and NK cells are also being eyed as autoimmune treatments, CAR T therapies are leading the charge—for good reason. “CAR T therapies have already demonstrated remarkable success in conditions like lupus and systemic sclerosis by selectively depleting autoreactive B cells, resulting in sustained immune reset,” Katy Rezvani, head of the Institute for Cell Therapy Discovery & Innovation at MD Anderson, told BioSpace in an email. The biopharma industry is now seeking to expand on this early success, with Bristol Myers Squibb, Kyverna, CRISPR Therapeutics and more progressing CAR T therapies in a wide range of indications, including SLE, multiple sclerosis and stiff person syndrome. Here, BioSpace reviews five of the most advanced players in this space and how they’re harnessing—and innovating on—CAR T technology to address autoimmune diseases. BMS Brings CAR T Cancer Expertise to SLE A leader in CAR T therapies for cancer, Bristol Myers Squibb is now leveraging its cell therapy expertise to address autoimmune diseases. The pharma is working on CD19 NEX-T , an investigational CAR T therapy designed to seek out the cell surface protein CD19, which is highly expressed in B cells. Once it binds to CD19, the CAR T construct activates, releasing a cocktail of inflammatory cytokines and other chemicals that destroy the target B cell. This approach is similar to how BMS’ CAR T therapy Breyanzi works—only this time, the pharma is using this mode of action not to kill cancerous B cells in lymphomas but to deplete defective immune cells that mistakenly attack healthy cells. In an email interview with BioSpace , Rosanna Ricafort, vice president and head of late development, hematology and cell therapy at BMS, called CD19 NEX-T a “top priority” for the pharma, with which it plans to “push the boundaries in immune-mediated diseases.” In service of this goal, the pharma is running the Phase I Breakfree-1 and Breakfree-2 studies of CD19 NEX-T in SLE. At the 66th Annual Meeting of the American Society of Hematology in December 2024, BMS presented early data from both trials showing that three patients followed for at least six months were able to stop all other therapies without showing new signs of disease activity. One patient hit the definition of disease remission at six months. Aside from SLE, BMS is also advancing CD19 NEX-T for multiple sclerosis (MS), for which it unveiled early data last month, pointing to encouraging safety and tolerability. The pharma expects to provide additional early-stage data from the Phase I CD19 NEX-T program this year, building up to pivotal trials as soon as the data allow. “Our ultimate goal is to target the root cause of disease and drive long-term, treatment-free disease control for patients with severe forms of these autoimmune diseases,” Ricafort said. Kyverna Targets First CAR T Therapy for Stiff Person Syndrome This year, Kyverna Therapeutics is anticipating several key milestones for its investigational CAR T therapy KYV-101. Like BMS, Kyverna’s approach targets CD19 to eliminate dysfunctional immune cells, leading to what the biotech calls an “ immune reset ” in patients with autoimmune diseases. KYV-101 is unique in that it is designed specifically to avoid cytokine release syndrome and improve tolerability. Kyverna is testing KYV-101 for three target conditions : Stiff person syndrome (SPS), myasthenia gravis and lupus nephritis. Of these, the most mature indication is SPS, for which Kyverna expects to complete enrollment of a Phase II trial by mid-2025, building up to a topline readout in early 2026, CEO Warner Biddle told BioSpace in an email. Typically afflicting women more than men—and more frequently diagnosed in people 20 to 60 years of age—SPS is a rare disorder that arises when the body makes antibodies that attack the enzyme glutamic acid decarboxylase, which plays a role in the production of a neurotransmitter involved in muscle control. Common symptoms include muscle stiffness and painful spasms. If all goes well for Kyverna this year, the biotech expects to file a Biologics License Application for KYV-101 for SPS next year. “We believe this focused approach in SPS will enable us to deliver the first CAR T cell therapy in autoimmune disease to the market,” Biddle said. Beyond SPS, Kyverna is also looking forward to several catalysts in myasthenia gravis this year, including aligning with the FDA on a registrational path for the CAR T therapy in the first half of 2025, followed by a topline mid-stage readout in the latter half of the year. Kyverna’s autoimmune CAR T program is comprehensive, with the company having treated the most patients with a CAR T cell therapy so far, according to Biddle. CRISPR Homes in on Off-the-Shelf CAR T Market Seeking to build on the momentum from its Vertex Pharmaceuticals–partnered gene therapy Casgevy, CRISPR Therapeutics is now moving its allogeneic next-generation CAR T therapy CTX112 through clinical trials in various autoimmune diseases. The key advantage for CTX112 is its off-the-shelf availability, CRISPR Therapeutics Chief Medical Officer Naimish Patel told BioSpace in an email. “The drawbacks of autologous CAR T cell therapies”—those that draw cells from the patients themselves—“are that they are very expensive, require patients to stop their immunomodulatory therapy to get T cells harvested, are not widely available … and are associated with potentially severe side effects.” CRISPR Therapeutics is evaluating the potential of CTX112 in various autoimmune diseases, supported by safety, pharmacokinetic and pharmacodynamic data from cancer studies. The asset is currently in Phase I development for SLE, but at the 43rd J.P. Morgan Healthcare Conference in January, CEO Samarth Kulkarni bared the company’s plans to expand testing to other autoimmune indications. In its fourth-quarter and full-year 2024 business report last month, CRISPR Therapeutics revealed it had expanded its basket trial for CTX112 to include systemic sclerosis and inflammatory myositis. Updates for study are expected mid-2025, as per the biotech. “We see incredible potential for our allogeneic CAR T program, and we are looking forward to sharing a broad program update on CTX112 mid-year 2025,” Patel said. Autolus Awaits Q1 SLE Readout for Obe-Cel The only therapy on this list with an FDA approval under its belt is Autolus Therapeutics’ obecabtagene autoleucel, also called obe-cel, which was cleared by the regulator in November 2024 for relapsed/refractory B cell acute lymphoblastic leukemia. In this indication, obe-cel is marketed as Aucatzyl. Like most of the other assets in this class, obe-cel targets the CD19 epitope. Autolus is seeking to set its candidate apart from the rest of the space through a unique CAR construct that has what it calls a “ fast-off ” kinetic mechanism, which, unlike the traditional approach, enables the controlled binding of the CAR molecule to its target, in turn activating T cells in a similarly controlled manner. According to Autolus, this fast-off scheme closely mirrors the physiological interactions of T cells with their corresponding receptors. Results from a Phase Ib/II study of obe-cel in B-cell acute lymphoblastic leukemia, published in the New England Journal of Medicine in November 2024, suggest that Autolus’ fast-off approach improves T cell persistence and lowers exhaustion, leading to better clinical outcomes. More than half of patients achieved complete remission after obe-cel treatment, with an estimated 12-month overall survival rate of 61.1% Autolus still doesn’t have such detailed data for obe-cel in autoimmune diseases. The biotech is currently running the Phase I CARLYSLE study in advanced SLE, for which initial data are expected in the first quarter of this year, as per a November 2024 company presentation . Cabaletta Anticipates Multiple Catalysts for Rese-Cel in 2025 Cabaletta Bio—which launched in November 2018 with a stated focus on autoimmune disease—was ahead of the curve in this space. It is also the only company on this list that is developing its investigational cell therapy exclusively for autoimmune diseases. CABA-201 , also called resecabtagene autoleucel or rese-cel, is an investigational CAR T therapy that also targets CD19. What makes rese-cel unique is that it contains a 4-1BB domain, which is a protein commonly expressed on activated T cells that helps enhance their activity . Recent preclinical evidence has pointed to the potential of targeting 4-1BB to address autoimmune diseases. Cabaletta is testing this approach in the clinic with its Phase I/II RESET program, which is assessing rese-cel in a wide variety of autoimmune disorders, including myositis, SLE, systemic sclerosis, myasthenia gravis, MS and pemphigus vulgaris. Of these indications, the biotech named as primary focuses myositis, SLE and systemic sclerosis, for which rese-cel’s mechanism has the potential to “achieve robust improvement in clinical disease activity within 3 months of treatment,” according to its website . In a corporate presentation last month, Cabaletta unveiled initial clinical data from the RESET program, touting “consistent and deep” depletion of B cells 22 days after infusion. Additionally, treatment with rese-cel resulted in strong treatment response, pointing to the potential to achieve drug-free remission in patients with refractory disease. Similarly, rese-cel showed the potential of a “drug-free clinical response” in systemic sclerosis, while early data for SLE pointed to promising rates of remission. Cabaletta has several other rese-cel milestones lined up for 2025 , including more clinical and translational readouts throughout the year and a meeting with the FDA to align on a registrational path for the asset.