The Expanding CAR T Landscape: FDA-Approved Therapies and Clinical Impact Across B-Cell Malignancies
Panelists discuss how CAR T cell therapy has transformed lymphoma treatment with multiple FDA-approved products showing 70% to 80% overall response rates and 50% to 60% complete response rates across different B-cell malignancies, while emphasizing the importance of comparing clinical trial data with real-world evidence to understand true efficacy and safety profiles.
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The CAR T cell therapy landscape has dramatically transformed lymphoma treatment over the past decade, with multiple FDA-approved products now available for different B-cell malignancies. Current approvals include 3 products for large B-cell lymphoma (liso-cel and axi-cel for second-line therapy, tisa-cel for later lines), 2 for mantle cell lymphoma (brexu-cel and liso-cel), all 3 for follicular lymphoma, liso-cel for chronic lymphocytic lymphoma, and both brexu-cel and tisa-cel for acute lymphoblastic lymphoma. These therapies demonstrate remarkable efficacy with 70% to 80% overall response rates and 50% to 60% complete response rates that remain durable over 2 years.
Product selection requires careful consideration of multiple factors including disease biology, prior therapies, primary refractory status, and patient-specific factors such as ability to tolerate anticipated toxicities. Each CAR T product follows similar principles but differs significantly in efficacy profiles and safety characteristics. For primary refractory disease, specific products may be preferred based on their labeled indications and clinical trial data.
The transition from clinical trial data to real-world application presents unique challenges, as trial participants represent selected populations with specific eligibility criteria and demographics. Real-world registry data becomes crucial for validating clinical trial outcomes across broader patient populations. This comparison helps oncologists understand whether published prospective trial results accurately reflect outcomes in routine clinical practice, particularly important given the socioeconomic and logistical barriers that CAR T therapy presents to patients and health care systems.
