This isn’t really about Allogene as a company - it's about which allogeneic CAR T therapy can cement itself as the first-in-class. Multiple lines of evidence show that being first is often commercially more important than being better (1,2).
Cema-cel holds a commanding clinical lead, with over 250 patients already consented for measurable residual disease (MRD) screening in its pivotal trial (3). It targets a significantly larger market: frontline LBCL patients who have detectable MRD after initial treatment. In contrast, Azer-cel is confined to a narrower slice - third-line DLBCL patients who have relapsed after CAR T therapy. Not only is DLBCL just a subset of LBCL, but Azer-cel is positioned in a salvage setting with only ~3,000 eligible patients per year.
Cema-cel is designed to improve frontline outcomes and can be readily administered - sidestepping many of the logistical and manufacturing challenges that plague autologous CAR T therapies. If successful, it won't compete with autologous CAR T - it will replace them before relapse even occurs.
Basically, allogene has strategically positioned Cema-cel to exploit these advantages, and received RMAT designation from the FDA long before IMU even acquired Azer-cel (4). While Azer-cel faces a crowded, competitive niche, Cema-cel is collecting pivotal data now with the potential to redefine the CAR T treatment landscape entirely for LBCL.
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