Examining the Efficacy of CAR T-Cell Therapy Among Elderly Patients With R/R DLBCL

During the Great Debates & Updates (GDU) in Hematologic Malignancies meeting in New York, Samuel Yamshon, MD, Weill Cornell Medicine, New York, examines the efficacy of using chimeric antigen receptor (CAR) T-cell therapy to treat elderly patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL). 

Transcript:

Hi, I'm Sam Yamshon, and I'm the director of cellular therapy at Weill Cornell Medicine in New York City. I'm here at the Great Debates and Updates [in] Hematologic Malignancies [meeting] where, this morning, we discussed the role of CAR T-cell therapy in elderly patients with relapsed or refractory diffuse large B-cell lymphoma. 

I think from the data it's very clear that in the general population, CAR T-cell therapy is a very effective and potentially curative modality in diffuse large B-cell lymphoma that [has] relapsed following chemotherapy. But the question remains whether this is the best modality to use in elderly patients.

To answer that question, there are 3 critical questions that need to be addressed. Number 1, is it effective in elderly patients? [Number] 2, what are the toxicities in elderly patients that may preclude using these therapies? And [number] 3, what are the other options that are out there? 

To answer the first question, there's data both from clinical trials and from real-world cohorts that show that CAR T-cell therapy used in patients older than age 65 and even older appear to be just as effective against the lymphoma as in younger populations. In fact, in some real-world cohorts, there appears to be some signal that these treatments may actually be even more effective against the lymphoma than in younger patients that does appear not to compromise overall survival as well. 

In the question of toxicity, I think that there is data that for certain products, there appears to be a signal for increased neurologic toxicity in older patients, especially with the [axicabtagene ciloleucel] (axicel) product. But there do appear to be ways to mitigate some of that risk, including interventions such as a geriatric assessment or using prophylactic strategies. The toxicity profile in these elderly patients does not appear to compromise survival. To the last point, I think, currently, CAR T-cell [therapy] again really is a modality that is curative in a subset of these patients and so in a disease that is potentially curable I think that offering patients a therapy with curative intent is really important if patients are able to tolerate it. My approach in this population is to give CAR T-cell therapy as a rule.

There are some patients, I think, with comorbidities who may not be able to tolerate these therapies. Doing a very thorough assessment of the patient [who is] in front of you and assessing the degree to which their comorbidities may preclude them from getting CAR-T. For me, really, the critical point is there is no absolute age cutoff. It's much more about the patient [who is] in front of you and what comorbidities they have to answer the question of whether or not they should receive CAR T-cells.

Source: 

Yamshon S. Debate - Should Older Patients with Relapsed DLBCL Receive CAR-T Cell Therapy? Presented at the Great Debates and Updates in Hematologic Malignancies Meeting; April 5-6, 2024; New York, New York.