Dr. Frigault on Toxicity Differences Among CAR T-Cell Products in Leukemias, Lymphomas

Matthew Frigault, MD, clinical director of the Cellular Immunotherapy Program at Massachusetts General Hospital, discusses differences in the toxicities experienced with CAR T-cell products used in the treatment of patients with leukemias and lymphomas.

The question of safety is a difficult one, as different institutions and cancer centers have different treatment algorithms and approaches, according to Frigault. Based on the results of the ZUMA-1 trial, axicabtagene ciloleucel (axi-cel; Yescarta) appeared to have a higher toxicity rate compared with what has been reported with tisagenlecleucel (Kymriah) in the JULIET trial and lisocabtagene maraleucel (liso-cel; JCAR017) in the TRANSFORM trial. Institutions also use different grading systems for toxicities, which makes comparing data yielded from the different pivotal studies difficult, adds Frigault.

Real-world data from the JULIET study showed that severe cytokine release syndrome (CRS) occurred in less than 5% of patients, although 22% of patients experienced this effect in the pivotal study, according to Frigault. These findings prove to be comparable with what was seen with liso-cel in that this agent also showed much lower rates of severe CRS and neurotoxicity according to real-world data versus findings reported in the clinical trial. The reduced rates of toxicity observed with these products underscores the evolution of how these patients are being managed in clinical practice, Frigault concludes.