Catherine S. Diefenbach, MD

Catherine S. Diefenbach, MD, Associate Professor at NYU Grossman School of Medicine, Director of the Clinical Lymphoma Program, and Director of Hematology Translational Research at Perlmutter Cancer Center, in New York, called the findings from the TRANSFORM trial “very striking.”

“This study shows a strong progression-free survival advantage for lisocabtagene maraleucel,” Dr. Diefenbach said in an interview with The ASCO Post. “Patients who received lisocabtagene maraleucel had nearly 30% higher complete response rates compared with those who received autologous stem cell transplant, and the median progression-fee survival was 6.2 months for the transplant patients vs not reached for the lisocabtagene maraleucel patients.” Although there is not an overall survival advantage yet, Dr. Diefenbach also noted that with more time, “the median overall survival should start to favor lisocabtagene maraleucel.”

“These data clearly show that for patients who fit the parameters of the TRANSFORM trial chimeric antigen receptor [CAR] T-cell therapy is superior to autologous transplant,” she added.

Cautious Optimism

Despite the success of lisocabtagene maraleucel in the second-line setting, however, Dr. Diefenbach expressed doubts about its utility in the front-line setting. “Conventional chemotherapy regimens cure, on average, approximately 75% of all patients with large B-cell lymphoma,” said Dr. Diefenbach. “It’s tolerated, with no significant long-term toxicities, and it is relatively inexpensive.”

“CAR T-cell therapy, on the other hand, is a highly intensive and extremely expensive therapy that cannot be administered in a community hospital,” she continued. “In addition to being labor-intensive, it is associated with significant toxicities compared with front-line therapy, and it has not yet demonstrated superior efficacy. CAR T-cell therapy could potentially move up to patients with primary refractory disease, but I don’t think it’s going to be a front-line treatment to replace chemotherapy.”

According to Dr. Diefenbach, there are several trials in development looking at the bispecific antibodies, which are “markedly less toxic, even when combined with chemotherapy.” Bispecific antibodies could be integrated into the front-line setting if these trials are positive, she predicted. 

DISCLOSURE: Dr. Diefenbach reported no conflicts of interest.