Data Collected in Patients With DLBCL Reveal Real-World Trends for Use of Axi-Cel and Tisa-Cel

Data on the use of chimeric antigen receptor (CAR) T-cell therapies in the real-world setting show that axicabtagene ciloleucel (axi-cel; Yescarta) and tisagenlecleucel (tisa-cel; Kymriah) have mostly been used to treat patients with diffuse large b-cell lymphoma (DLBCL) in the outpatient setting with results suggesting earlier use may be possible in certain cases, according to an analysis presented at the virtual European Hematology Association Annual Meeting.

Looking at a total of 93 patients with DLBCL, 58% (n = 54) received axi-cel and 42% (n = 39) received tisa-cel, the majority of which (59%) received either CAR T-Cell therapy in the outpatient setting, compared to 40% in inpatient care. In a median follow up of 6.3 months, 45% of patients received either 2 or more lines of systemic therapy prior to receiving tisa-cel or axi-cel, while 17% received their systemic therapy after the CAR T-cell therapy. Tisa-cel or axi-cel was initiated at a median of 12.9 months following the initial diagnosis of DLBCL.

Commercial insurance was the primary payer during the time of therapy on either tisa-cel or axi-cel for 83% of patients with DLBCL, followed by 12% on Medicare, 3.2% on Medicaid, and 1 patient was unknown. Following CAR T-cell therapy, 82.8% did not receive therapy, 10.8% had 1 therapy after CAR T-cell therapy, and 6.5% had 2 therapies following either tisa-cel or axi-cel. For patients given systemic therapy following CAR T-cell therapy, a majority received rituximab (Rituxan) followed by, ibrutinib (Calquence), lenalidomide (Revlimid), nivolumab (Opdivo), and pembrolizumab (Keytruda). Researchers found a median of 4.4 months between CAR T-cell therapy and the next line of therapy.

Patients with at least 1 claim for either axi-cel or tisa-cel and were diagnosed with DLBCL were identified from the US claims database Symphony Integrated Dataverse (IDV) that houses 280 million active unique patients which represent 73% of specialty prescriptions, 58% of medical claims, and 30% of hospital claims. Nine patients were excluded due to having insufficient data, but initially 114 patients were identified to have been treated with either axi-cel or tisa-cel treatment, 21 of which were diagnosed with acute lymphoblastic leukemia (ALL).

Axi-cel and tisa-cel have been on the US market following their approval for treatment in patients with large b-cell lymphoma in 2017 and 2018 respectively. Data was looked at between 2018 to 2020, with the majority of patients initiated on CAR T-cell therapy in 2020 (41%).

“Despite short follow-up, 1 in 6 patients appear to have relapsed disease based on need for

additional systemic therapy,” the researchers concluded. “Further research is warranted to understand real-world clinical outcomes among patients treated with CAR T therapy outside the trial setting.”

Reference

Klink A, Savill K, Liassou D, et al. Real-World Treatment with CAR T-Cell Therapy of United States (US) Patients with Large B Cell Lymphoma (LBCL). Presented at: European Hematology Association 2021 Virtual Congress; June 9-19, 2021; virtual. Abstract EP737.