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ASH 2021 | Comparing axi-cel and tisa-cel in B-cell lymphomas

Peter M. Riedell, MD, University of Chicago Medicine, Chicago, IL, provides a comparison of axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel), both CD19-directed chimeric antigen receptor (CAR) T-cell therapies, in patients with relapsed/refractory aggressive B-cell lymphomas. Older patients were more likely to receive tisa-cel and progression-free survival was comparable between patients receiving axi-cel and tisa-cel. Tisa-cel had a superior safety profile, where more cases of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) were reported in the axi-cel arm. This interview took place at the 63rd ASH Annual Meeting and Exposition congress in Atlanta, GA.

Transcript (edited for clarity)

This was a multicenter analysis looking at outcomes in the real world, in patients that were prescribed either axicabtagene ciloleucel or axi-cel, or tisagenlecleucel or tisa-cel. This was a multi-institutional effort involving eight academic medical centers. And this was really an update of some data that we presented two congresses ago and kind of updates in terms of longer follow-up.

But what we really found in that was that there are different patient populations that get each of these different products...

This was a multicenter analysis looking at outcomes in the real world, in patients that were prescribed either axicabtagene ciloleucel or axi-cel, or tisagenlecleucel or tisa-cel. This was a multi-institutional effort involving eight academic medical centers. And this was really an update of some data that we presented two congresses ago and kind of updates in terms of longer follow-up.

But what we really found in that was that there are different patient populations that get each of these different products. What we’ve been seeing is that patients that are typically a little bit older are getting the tisagenlecleucel product compared to those that get the axi-cel products. I think one of the other striking differences that we noted is differences in some of the toxicity or profile that was noted in each of the patients and recipients of each of the products. We saw a little bit higher incidence of cytokine release syndrome, particularly more of those serious and severe grades in those of axi-cel recipients compared to tisa-cel and similarly higher incidence of ICANS or neurologic toxicity in those that received axi-cel compared to tisa-cel.

When we did an unadjusted analysis in terms of progression-free and overall survival, those actually appeared comparable, but certainly with having different patients receiving different products, it’s not necessarily a fair comparison. So we need to do some propensity score matching to better understand what patient may be best suited for what product.

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