Comparative Effectiveness of Anbalcabtagene Autoleucel versus Tisagenlecleucel in Patients with Relapsed/Refractory Diffuse Large B-cell Lymphoma

Abstract

Purpose: Anbalcabtagene autoleucel (anbal-cel) is a second-generation CD19-targeted chimeric antigen receptor-T cell therapy reducing T-cell exhaustion through PD-1 and TIGIT downregulation. We compared efficacy of anbal-cel with tisagenlecleucel (tisa-cel) in relapsed/refractory diffuse large B-cell lymphoma using external control arm study design.

Materials and methods: We performed a matching-adjusted indirect comparison (MAIC) using individual patient data from CRC01-01 (NCT#04836507) and aggregate data from JULIET trial (NCT#02445248). Primary outcomes were overall survival (OS) and progression free-survival (PFS), with corresponding hazard ratio (HR) and 95% confidence interval (CI) assessed using weighted Cox proportional hazard model. Secondary outcomes were objective response rate (ORR) and complete response rate (CRR), with corresponding odds ratio (OR) and 95% CI assessed using weighted logistic regression model.

Results: We included 79 patients in CRC01-01 and 115 in JULIET trial. In naïve comparison, median OS was not reached (NR; 95% CI 13.1-NE) for anbal-cel versus 11.1 months (6.6-23.9) for tisa-cel, corresponding to HR of 0.54 (0.34-0.87). Median PFS was 5.5 months (4.2-16.2) versus 2.9 months (2.3-5.2) with HR of 0.73 (0.50-1.08). ORR was 73.4% versus 53.0% with OR of 2.45 (1.32-4.54), and CRR was 64.6% versus 39.1% with OR of 2.83 (1.56-5.13). After applying MAIC to balance prognostic factors between the groups, adjusted HRs or ORs were 0.47 (0.23-0.95) for OS, 0.59 (0.36-0.96) for PFS, 2.60 (1.04-6.52) for ORR, and 3.00 (1.30-6.92) for CRR.

Conclusion: Anbal-cel showed superior effectiveness over tisa-cel, with higher response rates and improved survival outcomes, even after accounting for imbalances in prognostic factors at trial enrollment.

Keywords: Anbalcabtagene autoleucel; CAR T cell therapy; Indirect treatment comparison; Large B-cell lymphoma; Tisagenlecleucel.