Axi-cel vs Liso-cel CAR T-cell Therapy as Second LBCL Treatments

Learn the results from a real-world study that compared two CAR T-cell therapies, axi-cel and liso-cel, when used as second treatments for relapsed or refractory large B-cell lymphoma (LBCL). You will discover how well these treatments worked, how their side effects differed, and how these findings may influence your care decisions.  

When is CAR T-cell therapy used as a second treatment for LBCL? 

If LBCL stops responding or returns within 12 months of the first chemo-immunotherapy, patients are eligible for the CAR T-cell therapies axi-cel (Yescarta, Gilead/Kite) or liso-cel (Breyanzi, Juno Therapeutics/Bristol Myers Squibb) as a second treatment. 

Each CAR T-cell therapy was approved based on separate clinical trials, but they have not been directly compared in a randomized study. This can make it hard for patients and care teams to know how they compare in everyday care. 

How axi-cel and liso-cel compared in the real world 

Researchers used data from the French DESCAR-T registry, which collects real-world information on people receiving CAR T-cell therapy across France. Real-world data reflects what happens in routine care, not just in controlled clinical trials. 

The study included people with LBCL who had received one prior line of treatment and then received either axi-cel or liso-cel as a second therapy. To help the comparison be fair, researchers used statistical methods to balance differences between groups, such as age, health status, and lymphoma features. 

Overall survival and progression-free survival were similar between axi-cel and liso-cel. This means people lived about the same length of time and experienced similar control of lymphoma over time with either option. 

Response rates showed some differences: 

• Complete response rates were similar between treatments.
• Overall response rate was higher with liso-cel than with axi-cel. Overall response is the percentage of patients whose lymphoma was partially or completely reduced after treatment. 

For patients, this suggests that both options can be effective second treatments. While liso-cel led to more responses overall, this did not impact longer survival in this study. 

Side effect differences between treatments 

The biggest differences between axi-cel and liso-cel were seen in the side effects. 

Cytokine release syndrome (CRS) is an inflammatory reaction that can cause fever, low blood pressure, and other symptoms. CRS of any grade was more common with axi-cel, though severe CRS was uncommon with both treatments.

Neurologic side effects were much more frequent and severe with axi-cel. People treated with axi-cel were also more likely to need care in an intensive care unit. 

For people with LBCL, these differences can help you weigh treatment options with your care team. Side effect risk may influence which therapy is more manageable for your circumstance. 

Key takeaways for patients

In this real-world study, two CAR T-cell therapies were compared as second treatment options for LBCL. Although liso-cel showed higher overall response rates than axi-cel, both therapies had similar survival outcomes. Liso-cel had fewer neurologic side effects and CRS than axi-cel. Understanding these differences may help people with LBCL and their care teams choose the option that best fits their health needs and treatment goals. 

Questions to ask your healthcare team 

• Based on my health and lymphoma features, would axi-cel or liso-cel be a better option for me?
• What side effects should I expect with each CAR T-cell therapy, and how will they be managed? 
• How might my prior treatments or overall health affect which CAR T-cell therapy you recommend?

Read more real-world research about CAR-T for lymphoma: Real World Outcomes of Liso-cel for Large B-cell Lymphoma

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Source: 

• Comparison of axi-cel versus liso-cel as 2nd line therapy for relapsed/refractory large B-cell lymphoma in real-life: A lysa study from the descar-T registry