OnCo
ideasIdea

Head-to-head bispecific vs CAR-T in second-line LBCL

Nobody has directly compared an off-the-shelf bispecific with CAR-T in the same patients; a trial would settle where each belongs.

CAR-T has phase 3 EFS and OS wins in early relapse; bispecifics have single-arm activity and one mixed phase 3 (EPCORE DLBCL-1). Access, cost, and vein-to-vein time favour bispecifics.

Hypothesis
Epcoritamab or glofitamab with chemotherapy is non-inferior to axi-cel on EFS in second-line LBCL with a lower cost and comparable CRS.
Rationale
Both redirect T cells to CD19/CD20+ cells; bispecifics can be repeated and are available in a week.
What would test it
Randomised non-inferiority trial with EFS primary, quality-of-life and cost secondary; ctDNA-defined stratification.
Maturity
speculative

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