Dr. Andreadis Discusses FDA-Approved CAR T-Cell Therapies in DLBCL

Charalambos (Babis) Andreadis, MD, MSCE, associate professor of clinical medicine, Department of Medicine, University of California, San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center, discusses FDA-approved chimeric antigen receptor (CAR) T-cell therapies in diffuse large B-cell lymphoma (DLBCL).

There are 2 approved products now—–tisagenlecleucel (Kymriah), which is a 4-IBB product and axicabtagene-ciloleucel (Axi-cel; Yescarta), which is a CD28 product. They have very similar activity, says Andreadis. To date, clinical trials have shown response rates in the 50% range and long-term responses in 30% to 40% of patients, adds Andreadis.

However, they have different toxicity profiles. The toxicity with tisagenlecleucel is mainly low-grade cytokine release syndrome (CRS). There is a little bit of neurological toxicity, though it does not often require secondary agent support. Axi-cel has more of a robust and early onset toxicity profile, says Andreadis. Physicians have noted higher rates of CRS and neurotoxicity, as well as higher use of tocilizumab and steroids, which may make it more challenging to give in the outpatient setting.