VIDEO: CAR T-cell therapy ‘exciting’ in follicular lymphoma, but safety questions remain

Editor’s note: This is an automatically generated transcript. Please notify editor@healio.com if there are concerns regarding accuracy of the transcription.

T-cell therapy for follicular lymphoma is hugely exciting and maybe as a standalone therapy, one of the most potent therapies for follicular lymphoma with extremely high response rates and complete remission rates, and especially for these rare follicular lymphoma patients who have just had no response to some prior therapies. But it's still a bit of a nuanced call. You know, they're very elegant therapies, CAR T-cells, but we don't wanna oversell the safety of them. They do have risks of cytokine release syndrome, of we say ICON neurotoxicity, and certainly hospitalization, logistic obstacles to them. So we definitely wanna get these therapies available to all the right patients. And like with most therapies, patients, you know, that are treated a little bit earlier in the course of the disease have better outcomes. But it can sometimes be a tricky call now when we have so many good options to know the correct sequence, 'cause we don't know, we don't have good studies to say give A, B, C versus B, A, C or C, B, A. So when is the right time for CAR T-cells? The first thing is in an observed in many types of lymphoma and some other cancers as well, that the quality of the CAR T-cells has some proportionality to the quality of the T-cell that went into making those CAR T-cells. So we don't want patients who have been so beat up by chemotherapies, especially aggressive lymphodepletive chemotherapies, especially recently, that they can't make a good CAR T-cell product. So you know, the time for CAR T-cell therapies is before just burning through every possible chemotherapy. Absolutely. How we sequence CAR T-cell with some of the newer immunotherapies like bispecifics, very difficult. We're trying to get those answers now, but we don't have them. Intuitively you could say maybe give me the easier therapy first. If neither therapy will forego the other. You don't burn it Really any bridges in either direction. You can give CAR T-cells and then bispecifics or vice versa. So maybe give the easier therapy first. Bispecific antibodies, since they still have very high response rate, high complete remission rate and pretty impressive durations of remission. And certainly we have some patients we don't think they might tolerate the higher risk of CRS and neurotoxicity with CAR T-cells. So maybe give the easier thing first, easier and safer thing first, and maybe CAR Ts thereafter. We have this idea that maybe the bispecific antibodies might cause T-cell exhaustion and therefore the CAR T product may not be as good. We really have zero actual clinical data on that. So, as a hypothetical thing we should pursue that question a bit more. Find out if giving bispecifics three, six, nine, 12 months before CAR T-cell has any adverse impact, but lacking data I wouldn't guide therapy based on it. So we wanna get CAR T-cells before patients have really exhausted their T-cells due to chemotherapy and still how to figure out the best sequencing with other immunotherapies and other targeted therapies. Still figuring it out.