Blood cancer patients treated with CAR T-cell therapy have the same risk of second primary cancers as patients treated in other ways, according to a new study.
The US researchers say the findings may help reassure patients who are worried about the risk of second primary cancer, following the US Food and Drug Administration ‘blackbox’ warnings, which are based on adverse reporting data.
The research, published in Clinical Cancer Research, was based on meta-analysis of studies involving adult patients with lymphoma or multiple myeloma. The researchers found that within 21.7 months of follow up, 5.8% of patients developed a second primary cancer. There was no significant difference in rates between the different types of cancer for which patients were treated with CAR-T.
The analysis involved 18 clinical trials and seven real world studies, involving 5,517 patients in total.
Some 37% of the second primary cancers were blood cancers, and these included myelodysplastic syndrome and acute myeloid leukaemia. T-cell malignancies represented just 1.5% of second primary cancers.
The researchers found four clinical studies which compared outcomes for CAR-T therapy with standard of care treatment. These involved 1,253 patients. 5% of CAR T patients developed secondary cancers as did 4.9% of those who received standard care.
Researcher Dr Kai Rejeski, from the Adult Bone Marrow Transplant Service at Memorial Sloan Kettering Cancer Center, New York, said: “These data do not suggest that there is an increased risk of second primary malignancies relative to other standard-of-care therapies. I worry that the warning labels may intimidate patients who receive this therapy, which may not be entirely founded.
“CAR-T therapy is the first treatment in more than 20 years to show an overall survival benefit compared to the standard of care in refractory large B-cell lymphoma. I would strongly caution against withholding this therapy because of the miniscule risk of developing T-cell malignancies.”
Source:
Tix T, Alhomoud M, Shouval R, Cliff ERS, Perales MA, Cordas Dos Santos DM, Rejeski K. (2024) “Second primary malignancies after CAR T-cell therapy: 2 A systematic review and meta-analysis of 5,517 lymphoma and myeloma patients.” Clinical Cancer Research, 11 September 2024, doi: 10.1158/1078-0432.CCR-24-1798
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