Dr Nastoupil on the Use of Liso-Cel in Relapsed/Refractory Follicular Lymphoma

Loretta J. Nastoupil, MD, associate professor, director, Lymphoma Outcomes Database, section chief, New Drug Development, Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses the rationale for investigating the use of lisocabtagene maraleucel (Breyanzi; liso-cel) in patients with relapsed/refractory follicular lymphoma (FL).

The phase 2 TRANSCEND FL trial (NCT04245839) evaluated the autologous, CD19-directed CAR T-cell therapy liso-cel in patients with indolent non-Hodgkin lymphoma. At the 2023 SOHO Annual Meeting, investigators presented data from the primary analysis of this trial in patients with relapsed/refractory FL, showing that the use of liso-cel in this patient population resulted in deep and durable remissions.

The key primary and secondary end points of the open-label, single-arm, multicohort, multicenter trial were met, with liso-cel eliciting an overall response rate of 97% (95% CI, 91.6%-99.4%; P < .0001) and a complete response rate of 94% (95% CI, 87.5%-97.8%; P < .0001). Moreover, following a median follow-up of 16.6 months, the median duration of response (DOR) was not reached (NR; 95% CI, 18.0 months-NR), and the 12-month DOR rate was 81.9% (standard error, 3.99). Additionally, at a median follow-up of 17.5 months, the median progression-free survival (PFS) not reached (95% CI, 19.0 months-NR) and the 12-month PFS rate was 80.7% (standard error, 3.99).

CAR T-cell therapy has transformed the treatment landscape for patients with chemotherapy-refractory large-cell lymphoma, Nastoupil explains. However, in FL, where the natural history of the disease is prolonged, most patients anticipate a normal life expectancy, thus raising questions about the use of CAR T-cell therapy in this population. Associated toxicities and costs are important to consider when deciding which patients should receive a treatment such as CAR T-cell therapy, she emphasizes.

Historically, patients whose disease quickly progresses following treatment with chemoimmunotherapy have less favorable outcomes, Nastoupil continues. Those patients whose FL behaves like transformed disease are most likely to benefit from CAR T-cell therapy, Nastoupil concludes.