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Expert Outlines Key Factors in Selecting CAR T-Cell Therapies for Follicular Lymphoma

• Two FDA-approved CAR T-cell therapies, Yescarta and Breyanzi, are now available for relapsed/refractory follicular lymphoma patients who have received at least two prior lines of therapy.

• Institution-specific factors, including product availability, established protocols, and healthcare team expertise, significantly influence the selection between different CAR T-cell therapies.

• Patient-specific characteristics such as age, comorbidities, tumor burden, and treatment urgency play crucial roles in determining the optimal CAR T-cell product choice.

The landscape of treatment options for follicular lymphoma (FL) continues to evolve with the availability of multiple CAR T-cell therapies, presenting both opportunities and decision-making challenges for healthcare providers. Dr. Francisco Hernandez-Ilizaliturri from Roswell Park Comprehensive Cancer Center provides insights into the complex factors influencing CAR T-cell therapy selection for FL patients.

Current Treatment Landscape

The FDA has approved two distinct CAR T-cell therapies for adult patients with relapsed/refractory follicular lymphoma who have undergone at least two prior lines of therapy. Axicabtagene ciloleucel (Yescarta) received approval in 2021, while lisocabtagene maraleucel (Breyanzi) secured accelerated approval in 2024, expanding the therapeutic arsenal for this patient population.

Institutional Considerations in Treatment Selection

The selection process for CAR T-cell therapy varies significantly across healthcare institutions. Dr. Hernandez-Ilizaliturri emphasizes that product availability, safety profiles, and institutional experience play pivotal roles in treatment decisions. Healthcare centers often develop preferences based on their familiarity with specific products and their established protocols.

Patient-Specific Factors

Treatment selection is highly individualized, taking into account multiple patient characteristics:
  • Age and comorbidities
  • Tumor burden
  • Treatment urgency
  • Overall clinical condition
Dr. Hernandez-Ilizaliturri notes that manufacturing time can be a crucial consideration. For patients with high tumor burdens requiring immediate intervention, newer CAR T-cell therapies with shorter manufacturing times may be preferable. Conversely, patients with lower tumor burdens but higher comorbidity risks might benefit from products with longer manufacturing processes that offer more favorable safety profiles.

Healthcare Team Expertise

The expertise and training of the healthcare team in administering specific CAR T-cell products emerges as another critical factor. Different products may require varying levels of specialized training and experience, influencing institutional preferences and treatment decisions.
"There is no one-size-fits-all answer to which CAR T-cell product is ideal for the management of FL," emphasizes Dr. Hernandez-Ilizaliturri. The optimal choice depends on a careful evaluation of individual patient needs, institutional resources, and healthcare team capabilities.
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Reference News

[1]
Dr Hernandez-Ilizaliturri on Selecting Between CAR T-Cell Therapies for FL - OncLive
onclive.com · Oct 11, 2024

Francisco Hernandez-Ilizaliturri discusses factors influencing CAR T-cell therapy selection for follicular lymphoma, inc...

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