Real world experience of approved chimeric antigen receptor T-cell therapies outside of clinical trials

Abstract

Advances in the field of immuno-oncology brought chimeric antigen receptor T (CAR T) cell therapy from the bench to the bedside for treatment of relapsed and/or refractory B-cell lymphoid malignancies. Two CAR T products, namely axicabtagene ciloleucel and tisagenlecleucel, are commercially available and represent genetically engineered T cells expressing chimeric receptors for CD19. These CAR T-cell products have undoubtedly revolutionized the treatment of these diseases yielding impressive complete remission rates and improving survival. This review aims at assessing the published evidence pertaining to the efficacy of these two products in the real world practice as enrollment in clinical trials often follows stringent eligibility criteria and involves possible selection bias. Results of various observational analyses from patients treated in the real world setting show comparable results to those reported in clinical trials in terms of efficacy and toxicities. This is certainly noteworthy considering that many of these patients would have been considered ineligible to participate in clinical trials owing to their less than optimal performance scores, among other reasons. We believe that the prohibitive cost of these treatments poses a serious challenge to wider applicability in the less privileged populations throughout the world, especially in developing countries. © 2020 Elsevier Masson SAS