Dr. Perales on Treatment With Approved CAR T-Cell Therapy

Miguel-Angel Perales, MD, deputy chief, Adult Bone Marrow Transplant Service, director, Adult Bone Marrow Transplantation Fellowship Program, Memorial Sloan Kettering Cancer Center, discusses determining which chimeric antigen receptor (CAR) T-cell therapy to use for patients with hematologic malignancies.

There are multiple FDA-approved CAR T-cell therapies for the treatment of patients with hematologic malignancies. In 2017, FDA approved tisagenlecleucel (Kymriah) in acute lymphoblastic leukemia (ALL) and axicabtagene ciloleucel (axi-cel; Yescarta) in non-Hodgkin lymphoma (NHL).

Choosing which CAR T-cell therapy to give to a patient has become a challenge, explains Perales. One consideration is which therapy is covered by the patient’s insurance. However, if there is an equal choice, it is important to balance the efficacy and safety of the treatment. It is hard to compare the studies of the CAR T-cell therapies side by side since they were not randomized trials, explains Perales.

Data with 4-1BB in the TRANSCEND study demonstrate some differences from other CAR T cells. Early data suggest that 4-1BB could have a better safety profile with lower levels of cytokine release syndrome, says Perales.