CAR-T therapies continue to be an important and effective treatment option for patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL); however, study results contend that alternate therapies may be just as efficacious in select clinical scenarios (Blood Adv. 2020;4[19]:4669-4678. doi:10.1182/bloodadvances.2020002118).
The prognosis of patients with relapsed or refractory… [DLBCL] is poor,” wrote David Sermer, MD, Memorial Sloan Kettering Cancer Center, New York, New York and colleagues.
“[CAR] T-cell therapy has been approved for relapsed/refractory DLBCL after 2 prior lines of therapy based on data from single-arm phase 2 trials, with complete responses (CRs) in 40% to 60% of patients. However, a direct comparison with other treatments is not available and, moreover, its true efficacy in real-world patients is unknown,” they continued.
The retrospective, observational study included 215 patients with relapsed/refractory DLBCL treated at Memorial Sloan Kettering Cancer Center. Outcomes of patients treated with CAR T-cell therapy (n = 69) were compared with outcomes of patients treated with alternate therapies (n = 146).
Patients treated with CAR-T therapies had a CR rate of 52% compared with 22% (P <.001) for patients treated with alternative therapies. Median progression-free survival (PFS) was 5.2 months versus 2.3 months (P = .01), respectively, and median overall survival (OS) was 19.3 months versus 6.5 months (P = .006), respectively.
Dr Sermer and colleagues noted this survival advantage appeared to persist irrespective of the number of prior lines of therapy.
After adjusting for unfavorable pretreatment disease characteristics, superior overall response rate in the CAR-T cohort remained significant. However, differences in PFS and OS between cohorts did not.
Additionally, Dr Sermer and colleagues noted that patients who responded to alternate therapies demonstrated prolonged remissions comparable to those 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 [relapsed/refractory] DLBCL. However, we contend that alternate therapies may be as efficacious as CAR-T therapy in select clinical scenarios,” Dr Sermer and colleagues concluded.
“Therefore, additional study continues to be warranted, ideally with randomized prospective trials,” they added.—Janelle Bradley
