Yescarta: Exploring How It’s Used To Treat Lymphoma

Immunotherapy is a type of cancer treatment that uses your own immune system to fight cancer. Chimeric antigen receptor (CAR) T-cell therapy is one small slice of the immunotherapy pie. It’s an innovative treatment that engineers cells from your immune system to better recognize and kill cancer in your body.

Yescarta (axicabtagene ciloleucel) is one example of CAR T-cell therapy. Yescarta was the first CAR T-cell therapy to be FDA approved to treat adults with large B-cell lymphoma, a type of non-Hodgkin lymphoma. It’s a unique medication, and it has a lot of potential to treat certain types of lymphoma — especially if you haven’t responded well to previous treatments. However, it can cause some serious side effects.

Here, we’ll discuss how Yescarta works, how effective it is, and side effects it can cause.

What is Yescarta?

Yescarta is a genetically-modified autologous T-cell immunotherapy. This means it’s a medication that’s made from your own T cells that have been altered to better identify and attack cancer cells in your body. It's also called a gene therapy medication because it genetically modifies your T cells.

Yescarta FDA approval

Yescarta is approved to treat people with certain types of non-Hodgkin lymphoma:

• Adults with relapsed or refractory large B-cell lymphoma. This includes diffuse large B-cell lymphoma (DLBCL), primary mediastinal large B-cell lymphoma, high grade B-cell lymphoma, and DLBCL from follicular lymphoma. It may be used when at least two other treatments haven’t controlled your cancer well.

• Adults with large B-cell lymphoma that’s refractory to a first-choice treatment or that relapsed within a year of receiving an initial treatment. 

• Adults with relapsed or refractory follicular lymphoma (FL) after two or more previous treatment attempts.

These uses may sound complicated. Relapsed cancer means the cancer went away with treatment and then came back. Refractory cancer means the cancer didn’t go away despite receiving treatment.

At this time, CAR T-cell therapy isn’t a first-choice treatment option for people living with cancer. It’s usually only used after other treatments haven’t worked.

How does Yescarta work for treating lymphoma?

Yescarta works by altering your immune system in a one-time dose. 

Your immune system is made up of many different types of white blood cells, including T cells. Your T cells’ main job is to find and kill foreign invaders in your body, like bacteria, viruses, or even cancer cells. They’re a key component of helping keep you healthy.

But, sometimes, T cells don’t work as well as we’d like them to. They may have a hard time finding cancer cells. This lack of efficiency allows cancer to keep growing inside your body. This is where immunotherapy medications like Yescarta can help.

Yescarta takes your own T cells and genetically modifies them in a lab with a special connector called a chimeric antigen receptor, or CAR. This connector helps T cells better recognize specific cancer cell antigens (proteins), like CD19. CD19 is often found on cancerous B cells. 

One dose of Yescarta infuses millions of engineered CAR T cells back into your body. These new and improved T cells give your body a much better chance of recognizing and killing cancer cells.

How is Yescarta given when treating lymphoma?

Yescarta is made using your own blood. To prepare your dose, your blood will be collected in a process called leukapheresis. After this, your blood cells will be sent to a manufacturing center to be engineered into Yescarta. 

When your dose of Yescarta is ready, it’ll be sent back to your treating healthcare provider so they can give it to you. It will be infused through your vein at an authorized treatment center. The infusion takes about 30 minutes, and it’s usually only given one time. 

But before you get Yescarta, you’ll likely get chemotherapy for a few days to prepare your body for the treatment. This is also known as a preparative chemotherapy regimen. Its purpose is to lower the number of T cells in your body so Yescarta can fully take the reins.

What is the recommended dosage for Yescarta? 

Each dose of Yescarta is unique. Dosages can vary from person to person because they’re based on how much you weigh and how many T cells are collected from your body during leukapheresis.

That being said, the recommended target Yescarta dosage is 2x10⁶ CAR-positive viable T-cells per kg of body weight. Your healthcare team will be in charge of determining your Yescarta dosage.

How effective is Yescarta according to clinical trials?

What we know about Yescarta’s effectiveness mostly comes from clinical trials. 

Yescarta was initially studied in about 100 people with large B-cell lymphoma who didn’t respond well to other treatment options. In the study, about 54% of people who received Yescarta had a complete response and about 82% had some response. The results of this study led to Yescarta’s approval in 2017 for the treatment of large B-cell lymphoma. 

Newer data from the trial also looked at how long people lived after receiving Yescarta. After about 4 years, 44% of people who were treated with Yescarta were still alive. 

What’s more, Yescarta was later studied in people with large B-cell lymphoma who’s cancer was refractory to their first treatment or who’s cancer came back within a year of their first treatment. Compared to people receiving standard treatments, those who received Yescarta as their second treatment had a 60% lower risk of cancer worsening, cancer-related death, or needing to start a new lymphoma treatment.

Yescarta’s effectiveness may vary for different types of lymphoma. Yescarta was studied in about 80 adults with FL who didn’t respond to two or more previous treatments. In this study, about 91% of people who received Yescarta experienced a partial remission. About 60% had a complete remission. Most of the people who saw some form of a remission remained in remission a year and a half after treatment. The responses seen in this study led to Yescarta’s accelerated approval for treating FL.

What are the potential Yescarta side effects?

Yescarta works by targeting cancer cells, but it can also affect healthy cells by mistake. This can lead to side effects. Some side effects of Yescarta are mild, but some can also become serious and life-threatening.

Common side effects

Some common side effects of Yescarta include:

• Fever

• Low white blood cells 

• Low red blood cells

• Low blood pressure

• Fast heartbeat

• Confusion

• Nausea

• Diarrhea

Serious side effects

Yescarta may also cause more serious side effects. Some of them may require treatment in a hospital. You should notify your oncologist immediately if any of the following serious side effects occur:

• Signs of cytokine release syndrome (CRS), which is when your immune system reacts more strongly than it should (a sudden increase in too many inflammatory cytokines can lead to organ failure or death)

• Neurological problems, like changes in awareness, difficulty speaking, and severe confusion

• Serious infection

• Hypersensitivity reactions, including anaphylaxis, difficulty breathing, and serious swelling

• Prolonged cytopenias, or low blood cell counts, that last for several weeks

Because of the risk of CRS and neurologic toxicities associated with Yescarta, a medication safety program — called Risk Evaluation and Mitigation Strategies (REMS) — has been implemented by the FDA. REMS programs help control the risks and side effects of a medication. Yescarta is only available through the Yescarta REMS program. And in January 2024, the FDA added a warning that links medications like Yescarta to rare cases of T-cell malignancies.

What’s more, some of these side effects, namely neurologic side effects, are more likely to happen in the first few weeks after treatment. It’s a good idea to avoid driving or performing other tasks that require focus during this time. 

How to save on Yescarta

Yescarta’s price without insurance or any discounts is relatively high. As of 2023, the list price of Yescarta is $424,000 for an infusion. But if you need help to cover the cost of Yescarta, there are ways you can save. 

If you have insurance, many commercial and Medicare plans have confirmed coverage for Yescarta. Your insurance plan provider can tell you more about your expected out-of-pocket costs.

A financial assistance program from Yescarta’s manufacturer, Kite Pharma, is also available. Kite Konnect is a program that serves as a resource to help you afford Yescarta. Kite Konnect can help with benefits investigations, potential reimbursement support, and programs to help cover the cost of therapy. For more information, call 1-844-454-5483 or visit Kite Konnect online.

What are some alternatives to Yescarta?

There are a few other gene therapy medications that can treat lymphoma too. They’re called Breyanzi (lisocabtagene maraleucel), Kymriah (tisagenlecleucel), and Tecartus (brexucabtagene autoleucel).

These CAR T-cell medications haven’t been directly compared to one another. So we don’t know for sure if one is better than the other. But there are some notable differences between each medication.

Tecartus vs.Yescarta

Tecartus and Yescarta share the same CAR design, but Tecartus goes through an additional manufacturing step that differs from Yescarta. This makes it a treatment option for people with B-cell cancers like mantle cell lymphoma (MCL). 

For this reason, Tecartus is approved to treat adults with relapsed or refractory MCL and adults with relapsed or refractory B-cell precursor acute lymphoblastic leukemia (ALL). Yescarta is not approved for these uses.

Kymriah vs. Yescarta

Kymriah and Yescarta share similar approvals. For instance, Kymriah and Yescarta are both approved to treat relapsed and refractory large B-cell lymphoma along with FL. But there are a few differences between them, too.

Kymriah is approved to treat people up to age 25 with B-cell ALL. Yescarta is approved to treat large B-cell lymphoma as a second treatment option in people whose first treatment didn’t work or cancer came back within a year.

Breyanzi vs. Yescarta 

Breyanzi and Yescarta share the same approvals and are generally considered alternatives to each other. They’re both approved to treat relapsed or refractory large B-cell lymphoma and relapsed or refractory FL. Like Yescarta, Breyanzi is also approved to treat large B-cell lymphoma as a second treatment option in people whose first treatment didn’t work or cancer came back within a year.

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Written by:

Sonja Jacobsen, PharmD, BCPS, BCOP

Sonja Jacobsen, PharmD, BCPS, BCOP,  is a clinical oncology pharmacy specialist currently practicing in Seattle. She has been practicing as a pharmacist since 2015 and is licensed to practice in Washington state and North Carolina.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Christina Palmer, MD

Christina Palmer, MD, is a board-certified family physician with a special interest in chronic care management, women’s health, mental health, and preventive care. She has over 10 years of experience in primary care research, innovation, and practice.

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