Dr Phillips on the Shifting Treatment Paradigm For CAR T-Cell Therapy in LBCL

Adrienne Phillips, MD, MPH, hematologist/oncologist, Director of Cell Therapy and Bone Marrow Transplantation Northern Regions, RWJBarnabas Health, associate professor, medicine, Rutgers Robert Wood Johnson Medical School, discusses the impact of CAR T-cell therapy on the treatment paradigm for patients with large B-cell lymphoma, highlighting key advancements in the decision-making process for CAR T-cell therapy selection.

The emergence of CAR T-cell therapy has transformed the treatment of hematologic malignancies, particularly in B-cell lymphomas, non-Hodgkin's lymphoma (NHL), and multiple myeloma, Phillips begins. Currently, 6 CAR T-cell products have received FDA approval for various hematologic subtypes, emphasizing the substantial advancements in the space, as well as the expansion of therapeutic options, Phillips states.

Despite the plethora of available options for patients with relapsed large B-cell lymphoma (LBCL), those who have not undergone transplantation following progressing on frontline therapy typically experience a poorer prognosis of approximately 10 months, Phillips notes. However, the use of CAR T-cell therapy has caused a notable shift in survival curves for this patient population, she says. Improvements in the Kaplan-Meier curve indicate that CAR T-cell therapy could have curative potential, especially when utilized in as a second- or later-line therapy, Phillips explains.

The efficacy of CAR T-cell therapy, particularly for those who relapse within the first year or have primary refractory disease, has also affected the treatment decision-making process in LBCL, Phillips continues. Traditionally, the decision to administer CAR T-cell therapy for patients with relapsed LBCL centered around their eligibility for transplantation, she details. However, the critical question is no longer about transplant eligibility, Phillips says, adding that further chemotherapy is unlikely to provide significant benefits for patients progressing on their initial line of chemotherapy. Instead, the paradigm has evolved to emphasize whether the body's inherent immune response can be successfully harnessed through the use of immunotherapy. This focus on leveraging the body's immune system to eradicate cancer represents a substantial departure from the dogma of the past 3 decades, Phillips concludes.