AXICABTAGENE CILOLEUCEL FOR THE TREATMENT OF RELAPSED/REFRACTORY DIFFUSE LARGE B-CELL LYMPHOMA IN BRAZIL: THE IMPACT OF CAR T-CELL THERAPY WAIT TIME AND TREATMENT SEQUENCING
Author(s)
João Samuel de Holanda Farias, MD1, Graeme Ball, PhD2, Bradley Kievit, MPH, MSc3, Rob Blissett, EngD3, Jayr Schmidt Filho, MD4.
1Hematology Department, Hospital Erasto Gaertner, Curitiba, Brazil, 2Kite, a Gilead Company, Santa Monica, CA, USA, 3Maple Health Group, New York City, NY, USA, 4Hematology Department, A.C. Camargo Cancer Center, São Paulo, Brazil.
1Hematology Department, Hospital Erasto Gaertner, Curitiba, Brazil, 2Kite, a Gilead Company, Santa Monica, CA, USA, 3Maple Health Group, New York City, NY, USA, 4Hematology Department, A.C. Camargo Cancer Center, São Paulo, Brazil.
OBJECTIVES: Patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) who are eligible for chimeric antigen receptor T-cell (CAR T) treatment may experience reduced clinical benefit when treatment is delayed or they receive non-CAR T treatments. In Brazil, real-world delays or misallocation to alternative therapies may increase risk of disease progression or death before infusion. This study assessed the impact of extended wait-times and treatment sequencing on outcomes in patients with R/R DLBCL in Brazil.
METHODS: A discrete event simulation was used to model patients with R/R DLBCL from progression after first-line through fourth-line therapy. The wait-time analysis compared a 23-day wait time, consistent with trial conditions, against delays of up to 120 days, informed by Brazilian real-world data in similar malignancies. Mortality during the waiting period was estimated from real-world data on death before second-line therapy. The treatment sequencing analysis explored scenarios in which 0-50% of CAR T-eligible patients were assigned to non-CAR T treatment pathways, contrary to international guideline recommendations. Outcomes included life years (LYs), quality-adjusted life years (QALYs), and excess mortality.
RESULTS: Assuming a 23-day wait-time, the model estimated 6.24 LYs and 4.30 QALYs, with 6.40% mortality before infusion. Extending wait-time to 120 days reduced LYs by 0.54 and QALYs by 0.37, while increasing pre-infusion mortality to 15.79%. Nationally, this translated to 112 excess deaths annually, with eight additional deaths predicted for each additional week of delay. In the treatment sequencing analysis, life expectancy declined by 19.8 months at 50% misallocation to non-CAR T pathways compared with full CAR T access, and an estimated 111 lives were projected to be lost within five years at a 50% misallocation rate.
CONCLUSIONS: This analysis demonstrates that prolonged wait-times and misallocation to non-CAR T treatment pathways undermine the efficacy of CAR T therapy for patients with R/R DLBCL in Brazil.
METHODS: A discrete event simulation was used to model patients with R/R DLBCL from progression after first-line through fourth-line therapy. The wait-time analysis compared a 23-day wait time, consistent with trial conditions, against delays of up to 120 days, informed by Brazilian real-world data in similar malignancies. Mortality during the waiting period was estimated from real-world data on death before second-line therapy. The treatment sequencing analysis explored scenarios in which 0-50% of CAR T-eligible patients were assigned to non-CAR T treatment pathways, contrary to international guideline recommendations. Outcomes included life years (LYs), quality-adjusted life years (QALYs), and excess mortality.
RESULTS: Assuming a 23-day wait-time, the model estimated 6.24 LYs and 4.30 QALYs, with 6.40% mortality before infusion. Extending wait-time to 120 days reduced LYs by 0.54 and QALYs by 0.37, while increasing pre-infusion mortality to 15.79%. Nationally, this translated to 112 excess deaths annually, with eight additional deaths predicted for each additional week of delay. In the treatment sequencing analysis, life expectancy declined by 19.8 months at 50% misallocation to non-CAR T pathways compared with full CAR T access, and an estimated 111 lives were projected to be lost within five years at a 50% misallocation rate.
CONCLUSIONS: This analysis demonstrates that prolonged wait-times and misallocation to non-CAR T treatment pathways undermine the efficacy of CAR T therapy for patients with R/R DLBCL in Brazil.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
CO68
Topic
Clinical Outcomes, Health Policy & Regulatory, Health Service Delivery & Process of Care
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
Oncology