CAR-T Meeting 2023 | Clinical indications for CAR-T therapy in DLBCL & the possibility of moving CAR-T into earlier lines
Anna Sureda, MD, PhD, Catalan Institute of Oncology, Duran I Reynals Hospital, Barcelona, Spain, discusses clinical indications for CAR-T therapy in diffuse large B-cell lymphoma (DLBCL), commenting on the vast amount of clinical trials and real-world data (RWD) in this space. Dr Sureda also highlights approved agents in the second and third-line settings, and emphasizes the need for more research to identify additional indications for patients in the future. This interview took place at the EBMT-EHA 5th European CAR T-cell Meeting held in Rotterdam, The Netherlands.
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Transcript (edited for clarity)
Diffuse large B-cell lymphoma is nowadays probably the major indication for CAR-Ts and it’s the pathology of the disease where we have more patients being treated outside prospective clinical trials and in real-world. We have two major indications for CAR-T in relapsed/refractory diffuse large B-cell lymphoma. The first one is in those patients at fail at least two prior lines of therapy, so third-line or eventually later lines of therapy...
Diffuse large B-cell lymphoma is nowadays probably the major indication for CAR-Ts and it’s the pathology of the disease where we have more patients being treated outside prospective clinical trials and in real-world. We have two major indications for CAR-T in relapsed/refractory diffuse large B-cell lymphoma. The first one is in those patients at fail at least two prior lines of therapy, so third-line or eventually later lines of therapy.
Here we have three prospective clinical trials that were published several years ago. We have long-term follow-up of patients included there. We have quite a lot of patients being treated in real-world outside prospective clinical trials. Here we have evidence that CAR T can represent a curative therapy for at least 35 to 45% of the patients.
The next indication that we have that has been approved by both the FDA and the EMA, only for two constructs, so for axi-cel and for liso-cel, in third-line or plus we have the three constructs, axi, liso, and tisa-cel. For second line we have axi and liso-cel. And basically, it’s looking at primary refractory patients with diffuse large B-cell lymphoma and earlier relapses, so relapses within the first 12 months after the beginning of first-line treatment.
It’s already in this indication probably there are some data coming from real-world in US. I think that it’s too early to talk about a big number of patients being treated in real-world in Europe. And of course, probably there will be additional indications in the future. There are data indicating that for high-risk patients with diffuse large B-cell lymphoma, maybe CAR-T cell therapy could be an interesting treatment to check.
We have the data coming from the ZUMA-12 trial that included only around 50 patients. And for these high-risk patients, the use of axi-cel gave really an interesting duration of response rate, progression-free survival, and overall survival. Maybe that was only a proof of concept. Maybe in the future we will have prospective randomized clinical trials that would be trying to look for another indication for this group of patients.
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