Which type of CAR T cell therapy is best for patients with relapsed or refractory large B cell lymphoma?

The authors compared the safety and effectiveness of lisocabtagene maraleucel (liso-cel; Breyanzi) and axicabtagene ciloleucel (axi-cel; Yescarta) in patients with relapsed or refractory (r/r) large B cell lymphoma (LBCL).

The study found that both treatments were similarly effective but liso-cel was better tolerated in these patients.

Non-Hodgkin’s lymphoma (NHL) is cancer of the lymphatic system. Diffuse LBCL (DLBCL) is the most common type of NHL. Many patients achieve remission (signs and symptoms of cancer are reduced) with chemoimmunotherapy. However, up to 50% of patients eventually relapse (cancer returns) or have refractory (not responding to treatment) cancer.

Chimeric antigen receptor (CAR) T cell therapies are treatments in which a patient’s T cells (a type of immune cell) are changed in the lab to attack cancer cells. Liso-cel and axi-cel are CAR T cell therapies available as a third- or later-line for LBCL. However, the safety and effectiveness of these CAR T cell therapies in the treatment of r/r LBCL have not been directly compared with each other in clinical trials.

This study collected data from two separate clinical trials. 256 patients with LBCL were treated with liso-cel and 101 with axi-cel. The safety and effectiveness data were compared between the 2 therapies. 

Patients receiving liso-cel had a similar response to treatment (80.1%) as those receiving axi-cel (74.3%). Complete response to therapy was also similar between liso-cel (59.2%) and axi-cel (54.5%). 

Survival without cancer worsening was similar between liso-cel (6.3 months) and axi-cel (5.8 months). The overall survival was also similar for patients receiving liso-cel (19.9 months) and axi-cel (21.1 months).

A well known side effect of CAR T-cell therapies is cytokine release syndrome (CRS). CRS involves the release of inflammatory proteins called cytokines in the body. This can cause symptoms such as fever, headache, tiredness, nausea, vomiting and appetite loss, and skin rashes. Patients treated with liso-cel were 99% less likely to experience severe CRS compared to axi-cel. Other side effects such as neurologic problems were also significantly less likely in the liso-cel group. 

The authors concluded that liso-cel and axi-cel CAR T cell therapies had similar effectiveness in patients with LBCL. However, liso-cel had was better tolerated by these patients.  

This study may not be consistent in its findings due to the collection of data from two separate clinical trials. Direct comparisons are needed. This study was funded by Bristol-Myers Squibb, the manufacturer of liso-cel.