Dr Awan on the Impact of CAR T-Cell Therapy on the CLL Treatment Paradigm

“A caveat right now is that [CAR T-cell therapy] should not be used before we have patients who have truly [progressed following treatment with] both BTK and BCL-2 inhibitors. The results are promising; however, there is more to be done [with determining] better patient selection [and the right] timing to take patients to CAR T-cell therapy.”

Farrukh Awan, MD, professor, Department of Internal Medicine, member, Division of Hematology and Oncology, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, delves into CAR T-cell therapy and its impact on the treatment paradigm for chronic lymphocytic leukemia (CLL).

In March 2024, the FDA granted accelerated approval to lisocabtagene maraleucel (liso-cel; Breyanzi) for the treatment of adult patients with relapsed or refractory CLL or small lymphocytic lymphoma (SLL) who have previously received at least 2 prior lines of therapy, including a BTK inhibitor and a BCL-2 inhibitor, making it the first approved CAR T-cell therapy for relapsed/refractory CLL and SLL. The regulatory decision has made a major mark in the disease’s treatment paradigm thus far, Awan says.

With liso-cel now available for select patients with relapsed/refractory disease, he emphasizes that respective patients now have a treatment that could potentially lead to long remissions. However, liso-cel should not be used until the patients have exhausted their previous options of both BTK and BCL-2 inhibitors, Awan emphasizes. Although data for liso-cel have shown the promise of the agent, he says there is more work to be done to identify several factors that can influence treatment decisions. These include selecting the appropriate patients and identifying the proper timing to utilize CAR T-cell therapy. He explains that not all patients treated with CAR T-cell therapy will have the same length of remission.

Liso-cel is an exciting treatment option for patients with relapsed/refractory CLL, Awan concludes, but work remains to determine the optimal use of the CAR T-cell therapy in this patient population.