Pros and cons of CAR-T vs bispecific antibody therapies in third-line LBCL
| Characteristic . | CAR-T therapy . | Bispecific antibody therapy . |
|---|---|---|
| Curative potential | Confirmed at 5 years of follow-up | Data not yet mature; complete responses appear to be durable with short follow-up |
| Administration | Single infusion | Repeated infusions required |
| Off-the-shelf availability | Not currently | Yes |
| Time to treatment initiation | Several weeks required for product manufacturing | Treatment can be started immediately |
| Bridging therapy | Optional, but may be needed in patients with aggressive disease | Not needed |
| Geographic availability | Only at specialized, accredited centers | Community settings |
| Upfront commitment | Substantial: hospitalization often required for administration | Less than CAR-T: initial hospitalization required for dose escalation, although emerging data regarding safety of outpatient initiation |
| Caregiver support required | Substantial | Less than CAR-T |
| Time to best response | ∼1 month | ∼1.4 months |
| T-cell requirements | Dependent on T-cell health (manufacturing failures, bendamustine exposure) | No costimulatory domain, so relies on innate immunity, which may be impaired by T-cell exhaustion |
| Activity in CNS involvement | CAR-T has demonstrated activity and comparable safety in primary and secondary CNS lymphoma | Not yet studied |
| Real-world data | Comparable efficacy and safety in real-world cohorts as compared to clinical trial cohorts | No real-world data regarding safety or efficacy |
| Patient-reported outcomes | Clinically meaningful longitudinal improvements in quality of life in the second- and third-line settings | Data not yet published |
| Cost-effectiveness | Cost effective in the second and third lines | Not yet studied |
| Existing sequencing data | No data for CAR-T after BsAb therapy | Known efficacy and safety of BsAb therapy after CAR-T |
| Characteristic . | CAR-T therapy . | Bispecific antibody therapy . |
|---|---|---|
| Curative potential | Confirmed at 5 years of follow-up | Data not yet mature; complete responses appear to be durable with short follow-up |
| Administration | Single infusion | Repeated infusions required |
| Off-the-shelf availability | Not currently | Yes |
| Time to treatment initiation | Several weeks required for product manufacturing | Treatment can be started immediately |
| Bridging therapy | Optional, but may be needed in patients with aggressive disease | Not needed |
| Geographic availability | Only at specialized, accredited centers | Community settings |
| Upfront commitment | Substantial: hospitalization often required for administration | Less than CAR-T: initial hospitalization required for dose escalation, although emerging data regarding safety of outpatient initiation |
| Caregiver support required | Substantial | Less than CAR-T |
| Time to best response | ∼1 month | ∼1.4 months |
| T-cell requirements | Dependent on T-cell health (manufacturing failures, bendamustine exposure) | No costimulatory domain, so relies on innate immunity, which may be impaired by T-cell exhaustion |
| Activity in CNS involvement | CAR-T has demonstrated activity and comparable safety in primary and secondary CNS lymphoma | Not yet studied |
| Real-world data | Comparable efficacy and safety in real-world cohorts as compared to clinical trial cohorts | No real-world data regarding safety or efficacy |
| Patient-reported outcomes | Clinically meaningful longitudinal improvements in quality of life in the second- and third-line settings | Data not yet published |
| Cost-effectiveness | Cost effective in the second and third lines | Not yet studied |
| Existing sequencing data | No data for CAR-T after BsAb therapy | Known efficacy and safety of BsAb therapy after CAR-T |