The 2022 Tandem Meetings | Impact of corticosteroids, tocilizumab or filgrastim on the outcomes of CAR-T therapy recipients
Poorva Bindal, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, discusses the results of a study assessing the impact of toxicity management strategies on the outcomes of patients treated with CAR-T therapy with 4-1BB costimulatory domain. It was found that patients treated with corticosteroids, filgrastim, and G-CSF had significantly worse overall survival (OS) and progression-free survival (PFS) compared to patients who did not receive these drugs. In contrast, tocilizumab was not found to have an impact on patient outcomes. This interview took place at the Transplantation & Cellular Therapy (TCT) Meetings of ASTCT™ and CIBMTR® 2022 in Salt Lake City, Utah.
Transcript (edited for clarity)
At our institution, our focus is to prevent and overcome resistance and relapse to CAR-T therapy after patients receive them. So, in the clinic, we decided to look at some of the strategies we use for toxicity management and see if those may be impacting outcomes in our patients. We specifically focused on patients who were receiving CAR-T therapy with the 4-1BB costimulatory domain. And the reason for that is that our population is seriously enriched for those patients...
At our institution, our focus is to prevent and overcome resistance and relapse to CAR-T therapy after patients receive them. So, in the clinic, we decided to look at some of the strategies we use for toxicity management and see if those may be impacting outcomes in our patients. We specifically focused on patients who were receiving CAR-T therapy with the 4-1BB costimulatory domain. And the reason for that is that our population is seriously enriched for those patients. As you may already know the prognostic impact of corticosteroids on patients who get the CD28-based costimulatory domain car CAR-T therapy has already been described. And studies have shown that higher dose and early use of steroids in those patients has led to worse survival.
We were not expecting to see such a major difference, but even in our population, we saw that patients although had similar response at 30 days, best response or need for post-CAR therapy, irrespective of if they got corticosteroids or not within those first 30 days, they did have significantly worse progression-free survival and overall survival in the order of the overall survival being a median of six months versus 60 something months. With tocilizumab, we did not see similar effects on progression-free survival and overall survival patients who got toci versus no toci actually did pretty similarly as far as their survival status was concerned. What was really surprising was with filgrastim or G-CSF support, we saw really major differences in patients who got filgrastim as part of their toxicity management in the first 30 days, versus those who did not. So the median overall survival was about six months in patients who got filgrastim and 60+ months in patients who did not. And we also stratified based on were these sicker patients, had they received more lines of therapy previously or had they previously received a transplant, but the impact actually was sustained in all of those populations too, and remain statistically significant. So at least at our institution, we think that this may be a little practice-changing. We are not as liberal with using G-CSF support as we were previously.
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