Some good news for liso-cel at last

With US approval at long last for Bristol Myers Squibb’s liso-cel, lymphoma doctors can make a direct comparison of FDA-curated data for the three anti-CD19 Car-T therapies now available. The good news for Bristol is that the agency broadly agrees with the safety and efficacy cited in the most recent cut of liso-cel’s pivotal Transcend study. Thus liso-cel, now branded Breyanzi, has efficacy on a par with Gilead’s Yescarta, with more durable responses and distinctly less cytokine release and neurotoxicity. This at least backs claims made by the product’s originator, Juno, that Breyanzi’s defined 50/50 CD4+/CD8+ T-cell ratio gives a more controllable and safer therapy. This is where the good news ends, however: hospital staff are becoming increasingly expert at handling such toxicities, and a defined-cell product is more expensive to manufacture than one generated from bulk cells. Margins on Car-T therapy are already vanishingly small, and whether Bristol can ever make Breyanzi profitable is a key unknown. And Friday’s approval is cold comfort for funds that had held contingent value rights related to Bristol’s Celgene acquisition: Breyanzi approval not having come by December 31, 2020, the security had already expired.