Dr Phillips on Treatment With Bispecific Antibodies and CAR T-Cell Therapy in MCL

Tycel Phillips, MD, MPH, associate clinical professor, Division of Lymphoma, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, discusses treatment with bispecific antibodies and CAR T-cell therapy in patients with mantle cell lymphoma (MCL), and other non-Hodgkin lymphomas (NHL).

Across various NHL subtypes, there are durable data on the use of CAR T-cell therapy, lending to the hypothesis that treatment with CAR T-cell therapy can be curative in certain patient populations, Phillips says. However, despite these data, treatment outcomes vary between subtypes, and the choice between CAR T-cell therapy and bispecific antibodies should be based on investigator preference. For example, some researchers are hopeful that CAR T-cell therapy is curative in follicular lymphoma (FL), as it is in other disease subtypes, Phillips notes. However, the curative potential of this therapy in FL is yet to be determined, and further research over the next several decades is needed to test this hypothesis, Phillips emphasizes.

However, the continued investigation of CAR T-cell therapies and bispecific antibodies in MCL may soon yield insights into the curative potential of these treatments in this population, Phillips expands. For example, glofitamab-gxbm (Columvi) is the only bispecific antibody with substantial data in MCL at present, Phillips says. However, these data are in a small number of patients, and investigators do not have data to accurately determine information such as how long patients respond to glofitamab treatment, when they will relapse, and how this agent effects T-cell quality, Phillips emphasizes.

Data regarding relapses are available for brexucabtagene autoleucel (brexu-cel; Tecartus), the current standard CAR T-cell therapy for patients with MCL, he continues. If the durability of response with brexu-cel is similar to that with glofitamab, oncologists will have multiple treatment options for patients with MCL who have certain characteristics, Phillips says. If the durability of response differs between the 2 agents, the choice will be whether to use the bispecific antibody first or reserve it for after CAR T-cell therapy, he concludes.