Key Findings
CAR T-cell therapy produced a pooled complete response (CR) rate of 70%, compared to 63% for bispecific antibodies (P < .05), in patients with relapsed or refractory (RR) mantle cell lymphoma (MCL). The overall response rate was 88% for CAR T-cell therapy and 75% for bispecific antibodies. Across all five studies analyzed, the overall pooled CR rate was 68% (95% CI, 62%-74%).
Technical Details
The analysis pooled data from 237 patients across five studies. The CAR T-cell group included products such as brexucabtagene autoleucel and lisocabtagene maraleucel, while the bispecific antibody group included CD20×CD3 antibodies mosunetuzumab and glofitamab. Median patient age ranged from 65 to 68.5 years, and most patients had received at least one prior Bruton tyrosine kinase inhibitor (BTKi).
- Safety: Grade 3 or higher cytokine release syndrome (CRS) rates were 6% for both treatment approaches (P > .05).
- Neurotoxicity: Grade 3 or higher neurotoxicity occurred in 21% of CAR T-cell therapy patients; data for bispecific antibodies was incomplete and could not be pooled.
- Variables: Researchers found no significant interaction regarding tumor proliferation marker Ki-67, TP53 mutation status, patient age, or baseline risk score.
Background and Context
Because the patient population is heavily pretreated, randomized head-to-head trials comparing these two cell-engaging approaches have not been conducted. The researchers utilized a systematic review and meta-analysis of single-arm trials from PubMed, Embase, and the Cochrane Library through October 2024 to fill this gap. The analysis followed PRISMA 2020 guidelines and was registered in PROSPERO.
Significance and Outlook
The researchers characterize these results as hypothesis-generating rather than definitive. Due to the lack of pooled survival data, the durability of responses—including progression-free and overall survival—remains unclear. Consequently, clinicians and payers must rely on individual trial data for sequencing and site-of-care decisions until prospective, head-to-head comparisons are available.
Source: https://www.ajmc.com/view/car-t-cell-therapy-tops-bispecific-antibodies-in-relapsed-mcl
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