Is CAR T-cell therapy more effective than salvage therapy for patients with DLBCL?

This study compared the effectiveness of T-cell therapy to salvage chemotherapy in patients with recurrent or hard-to-treat diffuse large B-cell lymphoma (DLBCL). This study found that lisocabtagene maraleucel (liso-cel; Breyanzi) T-cell therapy was more effective than salvage chemotherapy for these patients.

DLBCL is one of the most common types of non-Hodgkin's lymphoma (NHL). Chemoimmunotherapy is the typical first-line treatment for DLBCL. While most patients respond to treatment, relapse is common. Many patients also develop tumors that no longer respond to treatment. For these patients, the next step is typically salvage (rescue) therapy. The goal of this therapy is to eliminate remaining cancer or induce a response in refractory disease.

Chimeric antigen receptor (CAR) T-cell therapy involves modifying a patient’s own T-cells (a type of immune cell) to help them fight cancer cells. Liso-cel is a T-cell therapy that may help induce a response in patients with refractory disease. Whether this T-cell therapy is safer and more effective than salvage chemotherapy is unclear.

This study included a total of 892 patients with DLBCL that came back or stopped responding to previous treatments. 256 patients received liso-cel treatment (Group A) and 636 patients received salvage chemotherapy (Group B). Patients were followed up for an average of 2 years.

Significantly more patients in Group A responded to treatment compared to Group B (71.1% vs. 26%). Patients in Group A were 7 times more likely to respond to treatment compared to Group B.

Significantly more patients in Group A achieved a complete response (no signs of cancer after treatment) compared to Group B (49.2% vs. 7.0%). Patients in Group A were 12.9 times more likely to achieve a complete response compared to Group B.

On average, patients in Group A remained alive for significantly longer compared to Group B (20.5 months vs. 6 months). Patients in Group A remained alive for an average of 6.8 months without tumor growth or spread. Cell therapy was significantly associated with a 50 to 54% lower mortality risk compared to chemotherapy.

This study concluded that liso-cel T-cell therapy showed promising effectiveness for the treatment of recurrent or hard-to-treat DLBCL. The authors suggest that T-cell therapy may be a preferred treatment over salvage chemotherapy.

This study was funded by Bristol Myers Squibb, the manufacturer of lisocabtagene maraleucel. Also, this study compared the findings of two separate studies. More direct comparisons of liso-cel and chemotherapy are needed to confirm these results.