Usage Pattern of CAR-T and CD3xCD20 T-Cell-Engaging Bi-Specific Monoclonal Antibodies in B-NHL Patients in EU4 + UK
Authors: Ruiz Magdalena , Pérez Ángela , Alonso Isabel , Anger Caroline , Moehler Thomas , Solari María Leticia , Cuns Daniela Ivanna , Ferrerosa Lauren , French James A , Jindal Kriti 
Published: December 2024

Introduction:
The treatment landscape of B-cell Non-Hodgkin Lymphoma (B-NHL) is evolving with the advent of Chimeric Antigen Receptor T-cells (CAR-T) and CD3xCD20 T-cell-engaging bispecific antibodies (TCE-BsABs), offering new hope for patients. While CAR-T therapy represents a significant advancement, its accessibility is limited by the need for specialized facilities and the lengthy production time. Conversely, TCE-BsABs present a more readily available option, potentially enhancing treatment efficacy when used alone or alongside chemotherapy. Analyzing market research data on European treatment patterns can provide valuable insights into the adoption and outcomes of these innovative therapies.
Material & Methods:
This study was conducted using Oncology Dynamics, an online secondary market research survey collecting anonymized patient data, from a representative panel of physicians. Data for B-NHL patients, including patients in clinical trials, were collected between Q1 2019 to Q1 2024 from 5 European (France, Spain, Germany, Italy, & UK) countries. 218 of these patients are currently receiving CAR-T and 83 patients are on TCE-BsABs. Differences between the two population proportions were assessed using the z-test.
Results:
More than 60% of patients receiving CAR-T or TCE-BsABs were male, around 80% aged over 50 years, and over 95% are in a good-moderate condition (ECOG 0-2). Refractory disease was observed in 112 (51%) receiving CAR-T and 40 (48%) TCE-BsABs versus relapsed disease in 78 (36%) and 30 (36%), respectively. Approximately 80% of patients in both treatment arms presented advanced (III-IV) Ann Arbor stage.
Significant differences (p&lt;0.05) between the treatments (CAR-T vs TCE-BsABs) were found in the following patient characteristics: patients aged 51-75 years with 164 (75%) vs 52 (63%) and over 75 years, 9 (4%) vs 18 (22%); patient´s frailty (information available in 75 and 49 patients, respectively) with 6 (8%) vs 15 (31%); lymphoma type: Diffuse Large B-cell Lymphoma (DLBCL) 194 (89%) vs 51 (61%) and Follicular Lymphoma (FL) 18 (8%) vs 31 (37%); line of therapy 1st line 14 (6%) vs 12 (14%), 2nd line 28 (13%) vs 4 (5%), and received autologous prior bone marrow transplant (BMT) 56 (26%) vs 10 (12%). Prior treatment for patients who received CAR-T therapy followed by TCE-BsABs therapy occurred in 16 (19%), whereas the administration of TCE-BsABs prior to CAR-T was reported only in 4 patients (2%) (p&lt;0,05).
Considering the time from diagnosis to the start of the current therapy, we analyzed the usage patterns in two predominant B-NHL types. In DLBCL we detected a trend towards earlier use for TCE-BsABs over CAR-T in the first 3 years since diagnosis (90 % vs 76%) while CAR-T were more frequently prescribed after ≥3 years from diagnosis (in 24 % vs 10%).
The opposite trend regarding the timing of treatment was observed for FL patients in which CAR-T therapy use was predominant for the first 2 years from diagnosis compared to TCE-BsABs (54% vs 13%), while post ≥5 years from diagnosis, TCE-BsABs were more used as a rescue treatment (66% vs 25%).
Conclusion:
This retrospective research explores the usage pattern of CAR-T and TCE-BsABs in B-NHL. We found TCE-BsABs to be used earlier in treatment, particularly in older and frailer patients, and were preferred for patients with FL, compared to CAR-T. Conversely, CAR-T therapy was more frequently administered in DLBCL, as second line therapy, and in patients who had relapsed after a prior BMT. Further clinical trials including real-world outcomes are needed to guide physicians in optimizing the use of these novel T-cell directed therapies and may support their possible role in earlier lines of therapy.