CAR T vs Bispecifics: Expanding CAR T Reach in B-Cell Malignancies
Panelists discuss how improving CAR T accessibility through reduced monitoring requirements could strengthen its position against bispecific antibodies in treatment decision-making, emphasizing that access considerations should only influence therapy choice when efficacy and safety are comparable, not when CAR T demonstrates superior outcomes.
EP: 1.The Expanding CAR T Landscape: FDA-Approved Therapies and Clinical Impact Across B-Cell Malignancies
EP: 2.CAR T Monitoring Strategies: Balancing Patient Safety With Quality of Life Considerations
EP: 3.CRS Management Insights With Liso-Cel: Comprehensive Analysis From Real-World Data in 1579 Patients and Implications for Safe Clinical Practice
EP: 4.Understanding ICANS Management With CAR T: Low-Grade Events With High Resolution Rates
EP: 5.CAR T vs Bispecifics: Expanding CAR T Reach in B-Cell Malignancies
Video content above is prompted by the following:
The therapeutic landscape for relapsed/refractory large B-cell lymphoma now includes bispecific antibodies alongside CAR T therapies, creating important treatment decisions for clinicians. Currently, 2 bispecific antibodies are approved for large B-cell lymphoma, though not in the second-line setting where CAR T therapies like liso-cel and axi-cel have established superior efficacy compared with previous standard of care in head-to-head randomized trials. The choice between these modalities often involves considerations of efficacy, safety, and practical accessibility factors.
Access and feasibility frequently influence treatment selection, as bispecific antibodies can be administered in outpatient infusion centers that may not have CAR T capabilities. For patients living far from CAR T centers or unable to manage the logistical requirements of CAR T therapy, bispecifics offer an alternative T-cell–engaging approach with similar toxicity profiles but different monitoring requirements. However, this accessibility advantage should be balanced against potential efficacy differences, particularly in settings where CAR T has demonstrated superior outcomes.
The fundamental principle should prioritize efficacy and safety over convenience when significant differences exist between treatment modalities. While access considerations are important, the primary goal should be improving CAR T accessibility rather than accepting potentially less effective alternatives. As the field evolves with earlier-line studies of both modalities, the treatment landscape may shift, but current evidence in relapsed large B-cell lymphoma supports CAR T as the preferred approach when accessible. Data like the comprehensive liso-cel analysis helps justify efforts to expand CAR T access by demonstrating that monitoring requirements can be optimized without compromising safety, potentially making this highly effective therapy available to more patients who could benefit from its superior efficacy profile.
