Infection risk shifts over time with both CAR T and bispecific antibody therapy
One-year infection risk was similar, while later hazard rose with bispecifics
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The overall risk of any infection in the first year after starting treatment is similar in people given different types of immune-modulating therapies for blood cancer, a new study shows.
The study specifically compared two types of immunotherapies: CAR T-cells and bispecific antibodies. Data suggest that in the first month of treatment, infection hazard was numerically lower with bispecific antibodies than with CAR T-cell therapy. From day 31 onward, infection hazard was higher with bispecific antibodies. Over the full year, the overall risk of any infection was comparable between the two treatments.
Study compares infection risk with two immunotherapies
An early-access version of the study, “Infectious complications following bispecific antibody or CAR T therapy in adult patients with hematologic malignancies: a retrospective database analysis,” was published in Blood Cancer Journal.
Immunotherapies, treatments that harness the immune system to attack cancer cells, have revolutionized care for blood cancers. CAR T-cells work by equipping cancer-killing immune cells called T-cells with a lab-made receptor that directs them to attack cancer cells. Meanwhile, bispecific antibodies bind to both cancer cells and T-cells at the same time, helping the T-cells attack the cancer cells.
Several CAR T-cell and bispecific antibody therapies have been approved to treat various forms of blood cancer. Although these immunotherapies can be highly effective at killing cancer cells, they can also weaken and disrupt key parts of the healthy immune system, which can increase the risk of infections. But is the risk of infection different between these two therapy types?
To find out, an international team of scientists analyzed data from a global electronic health record research network. The study included adults with multiple myeloma, diffuse large B-cell lymphoma, or follicular lymphoma, and compared 1,096 patients who received CAR T-cell therapy with 1,096 who received bispecific antibodies. The researchers matched the groups so they were similar in demographics, cancer type, co-occurring health problems, and prior treatments.
Statistical analyses showed that the overall risk of any infection during the first year of treatment was similar among patients receiving CAR T-cell therapy or bispecific antibody therapy. With both therapies, more than half of the patients experienced infections.
“Both groups experienced a substantial early infectious burden, highlighting the importance of early monitoring for all patients,” the researchers wrote.
Infection risk patterns differed over time
Looking at shorter time periods, researchers found that in the first month of treatment, infection hazard was slightly lower with bispecific antibodies than with CAR T-cell therapy, although the difference was not statistically significant, meaning the study could not rule out that it was due to chance. After the first month, infection hazard was significantly higher with bispecific antibodies than with CAR T-cell therapy.
The researchers said that these timing differences make sense given how the two treatments are administered: CAR T-cell therapy is typically given as a single infusion, whereas bispecific antibodies are given repeatedly over months of treatment. Nonetheless, the researchers stressed that these differences are not necessarily driven by the therapies themselves, as other factors not captured in the database may have affected the results.
The researchers also noted that infections were identified using diagnostic codes in electronic health records, which means some infections may have been missed or misclassified.
“While the rate of infection was comparable between cohorts during the early phase, [bispecific antibodies] were associated with higher coded rates of late-onset infections, mainly driven by respiratory, viral, and fungal infections. These findings should be interpreted as associative rather than reflecting differences attributable to treatment alone,” the researchers wrote.
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