ASCO: More CAR-T Results

As you know, because you pay attention to such things, CAR-T is a big deal in the world of lymphoma. I would say the big CAR-T news from ASCO for Follicular Lymphoma patients was the presentation on Kymriah (also known as tisagenlecleucel, or Tis-cel) and Relapsed/Refractory FL. We've known that CAR-T is effective for many FL patients. This research, from the phase 2 Elara Trial, also showed that it was much safer than Yescarta, the CAR-T treatment that has already been approved by the FDA for R/R FL. While 8% of Yescarta patients in the ZUMA-5 trial showed serious Cytokine Release Syndrome symptoms, none of the Elara patients did. That's major.

Still, the updated Yescarta (also known as Axi-cel) results at ASCO were also very good. They were reported in the presentation called "Interim analysis of ZUMA-5: A phase II study of axicabtagene ciloleucel (axi-cel) in patients (pts) with relapsed/refractory indolent non-Hodgkin lymphoma (R/R iNHL)." The trial included mostly FL patients, but also some with MZL, another indolent lymphoma.

Like Elana, the ZUMA-5 trial is a phase 2 trial. While Tis-cel had a better safety profile, Axi-cel did better with effectiveness -- 95% Overall Response Rate for FL patients (compared to 86% for Tis-cel), and 81% Complete Response for FL (compared to 66% for Axi-cel). 

After a median follow-up of 15 months, about 68% of the Axi-cel patients were still enjoying their Response. About 80% of those with a Complete Response were still responding.

I haven't seen a direct comparison of the two CAR-T types for R/R Follicular Lymphoma patients yet, but I'm guessing that one is coming soon. The question is inevitable -- which one is better?

I'm looking forward to an actual oncologist giving an opinion on this, but here's my guess on what that will be -- if you have talked to your doctor about treatment options, and you have the opportunity to get CAR-T, and only one is available to you, go with the one that is available. It will kind of be like a Covid vaccine -- both CAR-T types are effective and safe, one maybe a little more effective than the other, and one a little safer than the other. But both still good.

That's my guess, anyway.

CAR-T is still a while from being the only choice for FL. There's the issue of cost, which is significant. It's not 100% effective on every patient (though that number seems to be getting better all of the time). And it's potentially hard on the body, so it's possible that patients with other health issues might not be the best candidates for CAR-T.

But it's being studied a lot, and experts are very excited about the results of those studies. I really do think it's going to be a part of many of our futures, in some form.