SOHO 2025 | Integrating CAR-T into earlier lines of therapy: toxicity profiles & future considerations

What happens when we move CAR T-cell therapy to earlier treatment lines or study CAR T-cell therapy in other non-malignant disease contexts such as autoimmune disease? I think that this is really one of the more interesting questions in our field. What happens in terms of the toxicity profile? And I think particularly for hematotoxicity that’s going to be a really interesting question because when we provide CAR T-cell therapy in the second line or even in the first line of treatment, patients will not have received multiple lines of cytotoxic chemotherapy. So we would anticipate that patients arrive to treatment with more hematopoietic reserve than a patient that’s receiving CAR T-cell therapy in sixth or seventh line. But at the end of the day, this has to be studied, and this is just a hypothesis. Same goes also for infectious complications and secondary malignancies. For secondary malignancies in particular, you know, when a patient has received three, four, five lines of treatment, then receives an effective treatment in, let’s say, fourth or fifth line of their particular patient course, it’s really difficult to say if the secondary malignancy that developed in this patient is due to the first line of treatment, the second, the third, the fourth. And so we certainly are interested to see what happens when we present CAR T-cell therapy in the first or second line because then we can really try to understand better what is the real role that CAR T-cell plays in the development of secondary malignancies.

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