Axi-Cel, Mosunetuzumab Compared for Third-Line Follicular Lymphoma Management

A trials analysis has been conducted to compare the chimeric antigen receptor (CAR) T-cell therapy axicabtagene ciloleucel (axi-cel) with the bispecific monoclonal antibody mosunetuzumab as a third-line or later intervention for follicular lymphoma (FL). Findings were published in Transplantation and Cellular Therapy.

The investigators who performed the comparative analysis wrote that their results “show improved efficacy and more durable response for the treatment of third-line or higher relapsed or refractory FL with axi-cel relative to mosunetuzumab, with increased odds of all-grade [cytokine release syndrome (CRS)] and neurological events, but not grade 3 or higher CRS and [treatment-related adverse events (TRAEs)].”

The analysis was a matching-adjusted indirect comparison (MAIC) which incorporated the aggregate data of 90 patients who had participated in the GO29781 mosunetuzumab FL trial, and the individual data of 127 patients who had participated in the ZUMA-5 axi-cel trial.

Regarding efficacy findings from the comparison, axi-cel was associated with improved progression-free survival and duration of response, with estimated Cox regression hazard ratios (HRs) of 0.39 and 0.45, respectively. Axi-cel also had higher objective response rates and complete response rates, with odds ratios (ORs) of 3.87 and 2.80, respectively.

The investigators noted regarding safety results that axi-cel carried a higher rate of all-grade CRS and neurological events, with ORs of 5.54 and 3.54, respectively, but that there were no statistically significant differences in grade 3 or higher CRS or TRAEs between the two interventions.

Reference

Ray MD, Kanters S, Beygi S, et al. Matching-adjusted indirect comparisons of axicabtagene ciloleucel to mosunetuzumab for the treatment of relapsed/refractory follicular lymphoma. Transplant Cell Ther. 2024;30(9):885.e1-885.e11. doi:10.1016/j.jtct.2024.06.016