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Leo I. Gordon, MD, FACP
Leo I. Gordon, MD, FACP
Posted: Thursday, December 8, 2022
Findings published in Nature Medicine suggest that axicabtagene ciloleucel may be more efficacious—but also more toxic—than tisagenlecleucel in the third and later lines of treatment for relapsed or refractory diffuse large B-cell lymphoma (DLBCL). Although safety and efficacy differences between the two chimeric antigen receptor (CAR) T-cell therapies have not been well documented historically, this study, conducted by Emmanuel Bachy, MD, PhD, of Hospices Civils de Lyon, France, provided a matched comparison of individual patient data obtained from treatment with both.
The study analyzed 809 patients from the French DESCAR-T registry study who received at least two prior lines of therapy. The population had a median age of 63 and a median of three prior treatment lines. Separately, 21% of enrollees received a prior stem cell transplantation. The investigators used propensity score matching and inverse probability of treatment weighting to balance covariates between the treatment groups.
After 1:1 propensity score matching (n = 418), the best overall and complete response rates were respectively 80% and 60% in patients treated with axicabtagene ciloleucel, versus 66% and 42% for patients treated with tisagenlecleucel (P < .001 for both overall and complete response rate comparisons). After a median follow-up of 11.7 months, the 1-year progression-free survival rate was 46.6% with axicabtagene ciloleucel and 33.2% with tisagenlecleucel (hazard ratio [HR] = 0.61; 95% confidence interval [CI] = 0.46–0.79; P = .0003). Separately, 1-year overall survival was improved after axicabtagene ciloleucel infusion, compared with tisagenlecleucel infusion (63.5% vs. 48.8%; HR = 0.63; 95% CI = 0.45–0.88; P = .0072). Inverse probability of treatment weighting produced similar findings.
Of note, cases of both grade 1 or 2 and grade 3 or higher immune effector cell–associated neurotoxicity syndrome were significantly more frequent with axicabtagene ciloleucel, and this was also the case for grade 1 or 2 cytokine-release syndrome.
Disclosure: For full disclosures of the study authors, visit nature.com.
