Dr Denlinger on the Real-World Use of Axi-Cel and Liso-Cel in R/R LBCL

“It appears that efficacy differences between the two [CAR T-cell therapies] are not present.”

Nathan Denlinger, DO, a physician and assistant professor of hematology in the Department of Internal Medicine at The Ohio State University Comprehensive Cancer Center—James, discussed findings from a real-world study evaluating the efficacy, safety, and health care resource utilization of second-line CAR T-cell therapy in patients with relapsed/refractory large B-cell lymphoma (LBCL).

The study focused on patients with relapsed/refractory LBCL who had received second-line treatment with either lisocabtagene maraleucel (liso-cel; Breyanzi) or axicabtagene ciloleucel (axi-cel; Yescarta). Denlinger began by explaining that although both liso-cel and axi-cel have significantly transformed the treatment paradigm for relapsed/refractory LBCL, he also stated that there has been a lack of direct head-to-head comparisons between these therapies in routine clinical practice. To address this gap, investigators used the Flatiron Health Research Database, analyzing a cohort of 198 patients who had received liso-cel and 275 patients who had received axi-cel treated between April 2022 and June 2025. Since real-world patient populations often differ between each other, researchers used stabilized inverse probability of treatment weighting to balance key clinical covariates, including age, disease subtype, and performance status.

The key finding of the study, according to Denlinger, was that there were no statistically significant differences in efficacy between the 2 CAR T-cell products. Specifically, progression-free survival and overall survival (OS) outcomes were similar at the 9-month mark. For example, the adjusted 9-month OS rates were 82% (95% CI, 75%-90%) for liso-cel and 85% (95% CI, 81%-90%) for axi-cel. Denlinger noted that although axi-cel was more likely to be used for patients with primary refractory disease due to the speed of the manufacturing process, and liso-cel was more frequently used for older patients, these factors balanced each other out regarding overall effectiveness.

The study revealed a much more distinct divergence in safety and toxicity profiles, with liso-cel demonstrating a significantly more favorable profile. Denlinger highlighted that patients treated with liso-cel were significantly less likely to experience cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS) compared with those who received axi-cel. Adjusted data showed CRS rates of 30% for liso-cel vs 64% for axi-cel, and respective ICANS rates of 14% vs 36%. Furthermore, patients treated with liso-cel required significantly fewer pharmacologic interventions, such as tocilizumab (Actemra) and corticosteroids, for the management of these adverse effects.

Finally, Denlinger discussed the implications for health care resource utilization, noting that liso-cel was associated with shorter median hospital stays and lower rehospitalization rates.