Among patients with refractory large B cell lymphoma (LBCL), chimeric antigen receptor (CAR)-T cell therapy appears to yield superior long-term clinical outcomes to those seen with standard salvage therapy regimens, according to an analysis published in Blood Advances.
Treatments for LBCL, the most common non-Hodgkin lymphoma subtype, have improved over the past several decades, although survival outcomes among patients with refractory disease remains poor. Although salvage therapy, sometimes followed by autologous stem cell transplant, can be effective in this setting, curative options are not available.
CAR-T cell therapy is a promising therapeutic avenue for patients with relapsed or refractory disease in a variety of hematologic cancer settings. The ZUMA-1 study (ClinicalTrials.gov Identifier: NCT02348216), which evaluated the safety and efficacy of axicabtagene ciloleucel (axi-cel) in LBCL, showed an overall response rate of 82%. For this 2-year analysis, researchers compared longer-term outcomes among patients included in ZUMA-1 with those among patients who received salvage therapy.
ZUMA-1 data were compared with data from patients enrolled to SCHOLAR-1, which was a previous retrospective analysis of outcomes among patients with LBCL. Two sets of data were compared: a common support set for response (ZUMA-1, 80 patients; SCHOLAR-1, 340 patients), and a common support set for survival (ZUMA-1, 81 patients; SCHOLAR-1, 331 patients).
After propensity-score matching, analysis suggested that the overall response rate was improved in ZUMA-1 (83% vs 34%), as was the complete response rate (54% vs 12%, respectively).
A standardization analysis showed that median overall survival was not reached with axi-cel (median follow-up, 27.1 months; 95% CI, 11.5 months-not estimable) vs 4.1 months in SCHOLAR-1 (95% CI, 3.5-5.1 months).
“Axi-cel produced durable meaningful responses and long-term disease control in patients who otherwise lack curative treatment options,” the authors wrote. “In summary, our results indicate that axi-cel addresses, in part, the considerable unmet need for effective therapies in refractory aggressive LBCL that were identified by the SCHOLAR-1 global retrospective study.”
Disclosure: The study author(s) declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Reference
Neelapu SS, Locke FL, Bartlett NL, et al. Comparison of 2-year outcomes with CAR T cells (ZUMA-1) vs salvage chemotherapy in refractory large B-cell lymphoma. Blood Adv. 2021;5(20):4149-4155. doi:10.1182/bloodadvances.2020003848