Dr Ip on Reasons for Studying Real-World CAR T-Cell Therapy Outcomes in LBCL

“CAR T-cell [therapy] is now a curative option for second-line, third-line, or [later] LBCL. A lot of the trials [evaluating these agents] excluded certain patients, including very old or frail patients or [those with] different comorbidities. It’s always good to confirm these sort of rigorous trials with real-world data.”

Andrew Ip, MD, Hackensack Meridian Health’s John Theurer Cancer Center, Hackensack University Medical Center, discussed the rationale for conducting a retrospective real-world analysis of outcomes with CAR T-cell therapy in patients with large B-cell lymphoma (LBCL).

Although CAR T-cell therapy is a curative second- or later-line treatment option for many patients with LBCL, several clinical trials investigating this treatment class have excluded select patients who are elderly or have comorbidities, Ip began. Furthermore, real-world studies are often limited to sites within a single country, he explained. Therefore, it is important to confirm clinical trial findings in real-world, global patient populations, Ip asserted.

Ip and colleagues conducted a multinational comparative analysis of real-world outcomes with commercial CD19-directed CAR T-cell therapies in patients with LBCL.

This study included 501 patients from 4 centers in the United States and Israel who received commercial CAR T-cell products between April 2016 and January 2024. Patients who received tisagenlecleucel (Kymriah; n = 133) had inferior efficacy outcomes compared with those who received axicabtagene ciloleucel (axi-cel; Yescarta; n = 272) and lisocabtagene maraleucel (liso-cel; Breyanzi; n = 96). Additionally, patients who received liso-cel achieved higher overall response and complete response rates vs those who received axi-cel; however, the progression-free survival and overall survival rates were not significantly different between these populations. Moreover, liso-cel was associated with a more favorable toxicity profile compared with axi-cel. Findings were consistent between subanalyses of patients who received these CAR T-cell therapies in the second or later lines of treatment.