The impact of bridging therapy before Axi-cel in R/R LBCL patients

Dr Fred Locke from Moffitt Cancer Center in Florida shares the data that were presented at the oral session on real world data of cellular therapies for B cell lymphomas at ASH2023.

The results presented explored the impact of pre-treatment bridging therapy before administering Axi-cel, a CD19-directed CAR T-cell therapy, on outcomes for patients with R/R LBCL. Data from 1200 patients were collected through the CIBM-TR registry, using propensity score weighting to assess the effects of bridging therapy.

Analysis revealed that mild hepatic impairment, over three prior lines of therapy, or recent Axi-cel infusion increased the likelihood of receiving bridging therapy. Conversely, patients with histologic transformation or a longer time from diagnosis to leukapheresis (>12 months) were less likely to undergo bridging therapy.

Bridging therapy selection showed considerable heterogeneity, with 58% receiving CT with an anti-CD20 mAB, predominantly rituximab. Other approaches included CT alone, non-CT bridging therapies and in 10% of cases radiotherapy, either with or without systemic therapy.

After 36 months, patients with bridging therapy had an ORR of 70% and a CR of 51% with a mean PFS of 3.6 months. In patients without bridging therapy ORR and CR were 79% and 64%, respectively, with a mean PFS of 14.7 months. However, multivariate analysis did not find significant differences in axi-cell treatment outcomes between patients receiving and not receiving bridging therapy.

Toxicity profiles were generally similar, except for prolonged neutropenia and thrombocytopenia in the bridging therapy group. Axi-cel therapy consistently demonstrated effectiveness regardless of the bridging therapy type, and overall, bridging therapy did not enhance outcomes, except for responders.

In conclusion, bridging therapy is recommended only when disease progression is expected within the 3-week turnaround time required for Axi-cel manufacturing.

Reference:

Cook M et al, Real-World Evidence in the United States (US) of the Impact of Bridging Therapy Prior to Axicabtagene Ciloleucel (Axi-Cel) for the Treatment of Relapsed or Refractory Large B-Cell Lymphoma (R/R LBCL). 2023, #ASH103

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