Kerry Rogers, MD, Weighs CAR T Against Bispecifics in CLL

For patients with a blood cancer, the choice of a chimeric antigen receptor (CAR) T-cell therapy or a bispecific antibody is rarely a simple one, explains Kerry Rogers, MD, associate professor at The James–The Ohio State University Comprehensive Cancer Center. The biggest factor, she explains, is the potential for a cure with CAR T-cell therapy.

For patients, that can mean not having to return for a visit about their cancer, and most would accept lifelong undetectable disease as a cure, she explained. Rogers currently is treating a patient who is 9 years out from investigational CAR T-cell therapy, healthy, and without detectable chronic lymphocytic leukemia (CLL), the disease she primarily treats. For this disease, bispecifics remain investigational, but she still discusses available clinical trials with patients.

Still, she says, the trade-off is real. CAR T-cell therapy is more labor-intensive, whereas bispecifics require less infrastructure: no cell therapy lab and no apheresis. This makes treatment close to home, or in less-resourced settings, a major advantage. Geography matters, too. Many patients are older, and Rogers notes that driving 2 hours from a rural community is a hard ask. With CAR T-cell therapy, patients stay near the center and hope to return home if it goes well, while some prefer end-of-life care over a treatment demanding so much time away. She considers that choice entirely acceptable.

Bispecifics could bring care closer to home through community practices and the ability to reach more people with a meaningful benefit, but they are not a simple alternative, she underscored. They still require infusion clinic time and sometimes hospitalization, and they have some of the same toxicities, such as cytokine release syndrome—but without the need for lymphodepleting chemotherapy.

Rogers stressed that duration of benefit “has to be part of the discussion.” Either way, she adds, bispecifics are a more involved undertaking than CLL therapies, like a Bruton tyrosine kinase inhibitor. Ultimately, the decision weighs a potentially curative but resource-intensive option against one that may be more accessible but is not expected to be curative.