A significant proportion of patients with large B-cell lymphoma (LBCL) experience relapsed or refractory (R/R) disease after first-line therapy. Chimeric antigen receptor T-cell (CAR T) therapy is approved for R/R LBCL, yet real-world utilization remains unclear. This retrospective study evaluated treatment patterns and survival outcomes in patients potentially eligible for CAR T in the Flatiron Health Research Database. Patients diagnosed with LBCL from 2011-2024 who initiated a first-line therapy were assessed. Predictors of mortality before the opportunity to initiate second-line therapy were evaluated using competing risk regression models. Treatment patterns among a subgroup that initiated second-line and third-line therapy based on the dates of FDA indication approvals for CAR T were evaluated and stratified by fitness for CAR T based on age and ECOG score. Among 10,016 patients that initiated first-line therapy, 13% died within 1 year without initiating second-line, and 30% initiated second-line. In competing risk analyses, 11% of patients with ECOG score of 0/1/unknown (combined) died within 12 months of initiating first-line therapy, and before being able to receive a second-line therapy. Among patients deemed eligible and fit for CAR T, 25% received second-line CAR T, and 36% received third-line CAR T. Despite its curative potential, CAR T uptake remains low in potentially eligible patients, with many dying within 1 year of initiating first-line therapy and before the opportunity to receive CAR T. Early collaboration between the community oncologist and CAR T center, improved access, and expanded patient awareness strategies are needed to improve CAR T therapy uptake.
Perales et al. (Wed,) studied this question.