Dr Hernandez-Ilizaliturri on Selecting Between CAR T-Cell Therapies for FL

Francisco Hernandez-Ilizaliturri, MD, professor, oncology, Department of Medicine—Lymphoma; director, Lymphoma Research, head, Lymphoma Translational Research Lab; associate professor, Department of Immunology, Roswell Park Comprehensive Cancer Center; clinical professor, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, discusses factors that inform optimal CAR T-cell therapy selection for patients with follicular lymphoma (FL).

Two CAR T-cell therapies are currently FDA approved for the treatment of patients with FL. In 2021, the FDA approved axicabtagene ciloleucel (Yescarta) for the treatment of adult patients with relapsed/refractory FL who have received at least 2 prior lines of therapy. In 2024, the FDA granted accelerated approval to lisocabtagene maraleucel (Breyanzi) for the same indication. 

The selection of CAR T-cell therapy for patients with FL varies across institutions and is influenced by several factors, including product availability, safety profiles, and patient-specific considerations, Hernandez-Ilizaliturri begins. Different institutions may have different levels of experience with each CAR T-cell product, leading oncologists to favor one product over another based on their familiarity and their institutions’ established protocols, Hernandez-Ilizaliturri says.

Patient characteristics, such as age, comorbidities, tumor burden, and the urgency of treatment play a significant role in determining the most appropriate CAR T-cell product for each patient, Hernandez-Ilizaliturri notes. For example, some emerging CAR T-cell therapies have shorter manufacturing times, which may be advantageous for patients with high tumor burdens or those requiring prompt intervention, he explains. Conversely, patients with lower tumor burdens but higher comorbidity risks may benefit from receiving a CAR T-cell product with a longer manufacturing process that offers a more favorable safety profile, according to Hernandez-Ilizaliturri.

Given these variables, there is no one-size-fits-all answer to which CAR T-cell product is ideal for the management of FL, he reports. This decision is highly individualized and depends on the patient’s clinical situation and the available resources at the treating institution, he says. Furthermore, the expertise an institution’s health care team has administering specific CAR T-cell therapies can influence the choice of treatment, as the training required for administering different products may vary, Hernandez-Ilizaliturri concludes.