Dr Bansal on Outpatient Administration With Axi-Cel and Brexu-Cel in R/R NHL

Radhika Bansal, MBBS, hematologist and oncologist, Mayo Clinic, discusses findings on the real-world outpatient administration of axicabtagene ciloleucel (axi-cel; Yescarta) and brexucabtagene autoleucel (brexu-cel; Tecartus) in patients with relapsed/refractory (R/R) non-Hodgkin lymphoma.

This study aimed to assess whether these FDA-approved therapies could be safely administered outside of the hospital setting and how early management of adverse effects (AEs) might influence overall patient safety and response rates. The study involved analyzing the outcomes of patients who received CAR T-cell therapy in an outpatient setting. The focus was on comparing safety profiles and response rates between patients who received early management for AEs and those who did not.

Results from the analysis, which comprised patients who had received axi-cel or brexu-cel between January 2018 and December 2022 at Mayo Clinic in Rochester, showed that fewer patients with large B-cell lymphoma who were infused with axi-cel in the outpatient setting (n = 116) received more than 2 prior lines of therapy in the early management period compared with the late management period (31% versus 79%; P<.001). The median follow-up was 16.5 months in the early management period and 41.0 months in the late management period. The highest overall response rates were 88% in the early management period (84% complete response [CR]) and 75% in the late management period (58% CR). Median duration of response (DOR), progression-free survival (PFS), and overall survival (OS) were not reached in the early management period, whereas in the late management period, the median DOR, PFS, and OS were 12.9, 4.2, and 22.5 months, respectively.

Results indicated that outpatient administration of CAR T-cell therapies is both safe and feasible for patients with R/R NHL, aligning with previous studies. Importantly, patients who received early intervention for AEs demonstrated better safety profiles and potentially improved therapeutic responses compared with those who went without early management. Bansal emphasizes that this study highlights the importance of early AE management in enhancing patient outcomes. By ensuring timely intervention, health care providers can improve safety and efficacy in outpatient settings. The findings suggest that structured early management protocols could be beneficial for the broader adoption of outpatient CAR T-cell therapies.