Evaluating CAR-T cell therapies for treating blood cancers

This study aimed to review the safety and effectiveness of three chimeric antigen receptor (CAR) T cell therapies, axicabtagene ciloleucel (AXI; Yescarta), tisagenlecleucel (TIS; Kymriah), and lisocabtagene maraleucel (LIS; Breyanzi), for the treatment of blood cancers. 

This study concluded that AXI and TIS showed very good effectiveness but have important toxicity warnings. It was also concluded that LISl showed very good effectiveness and safety in clinical trials only. 

CAR-T cell therapy is a type of immune treatment recommended for certain blood cancers. They involve taking immune cells called T cells from a patient's blood and changing them in the laboratory to attack and kill cancer cells. 

Three CAR-T cell products, AXI TIS, and LIS, have been approved by the FDA for the treatment of certain blood cancers. These treatments provide a promising choice for patients with cancer that comes back or does not respond to traditional anti-tumor treatments. However, the safety and effectiveness of these three products are still not completely known. 

This study reviewed data from 33 prior studies relating to the use of CAR-T cells products for treating blood cancers. Overall, 2172 patients with non-Hodgkin lymphoma (NHL), acute lymphoblastic leukemia (ALL), chronic lymphocytic leukemia (CLL), and multiple myeloma (MM) were included. 

Overall the response rate for all 3 products was 73%. The overall response rate was 77% for AXI, 69% for TIS, and 73% for LIS. The complete response rate was 54% for all productions. The complete response rate was 52% for AXI, 57% for TIS, and 53% for LIS.

One common side effect for CAR-T cell therapy is cytokine release syndrome (CRS). It involves a release of inflammatory proteins that attack the organs. Symptoms vary from fever, fatigue, loss of appetite, muscle and joint pain, nausea, vomiting, diarrhea, rashes, fast breathing, rapid heartbeat, low blood pressure, seizures, headache, confusion, delirium, hallucinations. Overall, 13% of patients had severe CRS. 9% of those treated with AXI, 21% of those treated with TIS, and 2% of those treated with LIS developed severe CRS. 

Another common side effect of CAR-T cell therapy is immune effector cell-associated neurotoxicity syndrome (ICANS). This can lead to speech problems, trembling, seizures, and coma. Overall, 22% of patients developed ICANS. 31% of those treated with AXI, 8% of those treated with TIS, and 10% of those treated with LIS developed ICANS. 

This study concluded that AXI and TIS showed considerable effectiveness in practice but special attention is required with respect to life-threatening toxicity that can occur in certain situations. It was also concluded that LIS showed excellent effectiveness and safety in trials but lacked corresponding real-world data. 

This study pooled data from patients with different conditions. Effectiveness may vary across different blood cancers. Further studies are needed.