Real-World Findings Question CAR-T Therapy’s Benefit Over Other Therapies for DLBCL

Although real-world patients who received chimeric antigen receptor T-cell (CAR-T) therapy for relapsed or refractory diffuse large B-cell lymphoma (R/R DLBCL) showed better response rates, progression-free survival (PFS), and overall survival (OS) compared with past patients who received non-CAR-T therapy, overall PFS and OS with CAR-T therapy failed to remain superior after adjustment for unfavorable pretreatment factors. 

Researchers published their findings in the journal Blood Advances. 

“In the current study, we describe our single center experience treating patients with commercial CAR-T therapy for R/R DLBCL. We report response rates, PFS, and OS comparable to the pivotal trials and markedly better than outcomes seen in patients treated with alternate therapies before the CAR-T era,” wrote researchers from Memorial Sloan Kettering Cancer Center. “However, when adjusting for baseline unfavorable disease biology, the seemingly inferior outcomes associated with use of alternate therapies are less clear.” 

The retrospective, observational study included a total 215 patients, 69 of whom received CAR T therapy and a historical population of 146 patients treated with alternate, non-CAR-T therapy. 

Rates of complete response were 52% with CAR-T therapy and 22% with alternate therapies, according to the study. Median PFS was 5.2 months with CAR-T therapy and 2.3 months for alternate therapies. Median OS was 19.3 months with CAR-T therapy and 6.5 months for alternate therapies. 

When researchers adjusted for unfavorable pretreatment disease characteristics, the response rate remained significantly better with CAR-T therapy—but PFS and OS did not. Furthermore, patients who responded to alternate third-line therapy showed prolonged remissions comparable to patients who responded to CAR-T therapy. 

“In conclusion, the CD19-targeted CAR-T products axicabtagene ciloleucel and tisagenlecleucel remain an important treatment option for patients with R/R DLBCL. However, we contend that alternate therapies may be as efficacious as CAR-T therapy in select clinical scenarios,” researchers wrote. “Therefore, additional study continues to be warranted, ideally with randomized prospective trials.” 

—Jolynn Tumolo 

Reference: 

Sermer D, Batlevi C, Palomba ML, et al. Outcomes in patients with DLBCL treated with commercial CAR T cells compared with alternate therapies. Blood Adv. 2020;4(19):4669-4678. doi:10.1182/bloodadvances.2020002118