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Blood-based biomarkers and imaging measures may eventually serve as practical tools for monitoring disease activity in patients with metabolic dysfunction-associated steatohepatitis (MASH), according to a new analysis.¹

The retrospective phase 2b study, which explored the use of various non-invasive tests (NITs) to assess response to semaglutide, adds to growing evidence that the drug not only improves metabolic parameters but may also produce early and measurable liver benefits detectable through blood-based and imaging biomarkers.

If these NITs prove useful in further research, write the researchers, they could reduce reliance on repeated liver biopsies, which remain the current standard despite their limitations.

Although biopsy-confirmed histology is required for clinical trials, repeated biopsies are burdensome for patients and challenging for trial execution. As drug development accelerates, there is increasing pressure to validate NITs, such as liver stiffness measurement, fibrosis scores, or circulating biomarkers, as surrogate indicators of treatment response.

This new study, published in Alimentary Pharmacology & Therapeutics, assessed 268 patients with biopsy-confirmed MASH and fibrosis stages F1–F3 who completed 72 weeks of treatment and had both baseline and end-of-treatment biopsy and NIT measurements. Patients had been randomized to receive one of 3 semaglutide doses or a placebo. For this exploratory analysis, all semaglutide doses were pooled to increase statistical power.

The investigators examined 17 unique NITs, including liver enzymes (ALT, AST), CK18 fragments, FibroScan-based metrics (controlled attenuation parameter and liver stiffness measure [LSM]), composite fibrosis scores (FIB-4, ELF, ADAPT), and proprietary biomarker panels such as NIS-4, MASEF, and several SomaSignal tests.

Across the pooled semaglutide group, nearly all NITs showed meaningful reductions from baseline to week 72, with improvements emerging as early as week 28. Measures tied to inflammation, steatosis, or fibrosis demonstrated consistent downward trends. In contrast, the placebo group showed little change, reinforcing that the improvements were treatment related. These findings aligned with biopsy-based assessments from the original study, which showed higher rates of MASH improvement and lower rates of fibrosis progression among semaglutide recipients.

To quantify whether NITs could serve as treatment-response markers, investigators defined “responders” as those achieving a ≥20% improvement in a given NIT (or ≥0.5-unit reduction for ELF based on prior clinical significance criteria). By this definition, semaglutide recipients had significantly more responders across nearly all NITs compared with placebo. For example, large proportions of semaglutide-treated patients demonstrated improved liver stiffness, fibrosis scores, steatosis markers, and inflammatory signatures. These NIT improvements frequently corresponded with histological improvement, supporting their potential utility as surrogate end points.

The study also explored whether baseline NIT levels predicted spontaneous fibrosis improvement or progression in placebo recipients. In this prognostic assessment, lower baseline fibrosis-related NIT scores, such as FIB-4, ELF, PRO-C3, and the SomaSignal fibrosis score, were associated with greater likelihood of improvement. Conversely, higher baseline FIB-4 values were linked to fibrosis progression. These findings suggest that some NITs may capture disease trajectory independent of treatment, though larger validation studies are needed.

Another evaluation focused on whether patients moved across clinically meaningful risk categories after treatment. In subgroups with elevated baseline risk, such as those with liver stiffness ≥8 kPa or ELF ≥9.8, a substantially higher proportion of semaglutide-treated individuals shifted into lower-risk categories compared with placebo. More than half of patients receiving semaglutide with elevated liver stiffness dropped below the 8-kPa threshold by week 72, compared with only 21% of placebo recipients. Similar patterns were observed for higher thresholds (12 kPa) and for ELF-based risk assessments.

“LSM is of considerable interest given that it is already in use clinically to detect fibrosis in hepatic disease as part of risk stratification,” explained the researchers. Moreover, LSM is recommended in MASLD guidelines because of its convenience and low cost.”

Collectively, these results support the concept that NITs may serve as meaningful indicators of treatment response and fibrosis improvement in MASH. However, the authors caution that this analysis was exploratory and not powered for regulatory validation. With no correction for multiple comparisons and the absence of long-term clinical outcomes, additional research, including the ongoing ESSENCE phase 3 trial of semaglutide treatment in patients with MASH,² is needed before NITs can be adopted as formal surrogate end points.

References

1. Nitze LM, Ratziu V, Sanyal AJ, et al. Exploration of multiple non-invasive tests for assessing response to treatment in a semaglutide phase 2b trial in patients with MASH. Aliment Pharmacol Ther. Published online September 23, 2025. doi:10.1111/apt.70376

2. Sanyal AJ, Newsome PN, Kliers I, et al. Phase 3 trial of semaglutide in metabolic dysfunction–associated steatohepatitis. N Engl J Med. 2025;392(21):2089-2099. doi:10.1056/NEJMoa2413258

A new single-center analysis offers one of the most detailed real-world evaluations to date of how flow cytometry can be used to monitor chimeric antigen receptor (CAR) T cell expansion, persistence, and toxicity risk in patients with aggressive large B-cell lymphoma (LBCL). The study was recently published in Hematological Oncology.¹

The findings, based on 45 patients treated with commercial CAR T products, provide real-world evidence for integrating flow cytometry into routine CAR T follow-up. Although its prognostic value for survival requires further validation, its utility for toxicity risk assessment and longitudinal immune tracking positions it as a valuable component of CAR T patient management.

Though less sensitive than molecular assays, flow cytometry offers practical advantages for real-time monitoring, explained the researchers, noting the tool’s ability to flag early, high-risk expansion profiles that could help clinicians anticipate well known side effects of CAR T-cell treatment, allocate monitoring resources, and guide preemptive management strategies.

Despite transforming outcomes for many patients with relapsed or refractory LBCL, CAR T-cell treatment yields responses and toxicities that vary considerably from one patient to another. Early expansion of CAR T cells is essential to achieve an antitumor effect, yet this same immune activation can trigger serious inflammatory complications commonly associated with CAR T-cell treatment, such as cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS).

Most data linking expansion kinetics to clinical outcomes come from a controlled setting via clinical trials, leaving limited insight into real-world variability. The current analysis aimed to fill that gap by using flow cytometry, one of the most widely available and accessible laboratory tools, to characterize CAR T behavior from the time of infusion through 12 months of follow-up.

Among the 45 evaluable patients, the majority had advanced disease and a high prognostic risk profile. Most (89%) received axicabtagene ciloleucel (axi-cel) (Yescarta; Kite Pharma), and the remainder were treated with tisagenlecleucel (tisa-cel) (Kymriah; Novartis). The study found that both products produced rapid expansion in peripheral blood, but with distinct kinetic profiles. Axi-cel reached peak expansion earlier—typically by day 7—with substantially higher median peak levels than tisa-cel. Tisa-cel expanded more modestly and peaked later, around day 10.

These early expansion dynamics were meaningful clinically. Patients with higher CAR T cell expansion were more likely to develop immune-related toxicity. CRS occurred in nearly 87% of the cohort, and patients with grade 2 CRS displayed substantially higher expansion levels than those without CRS. ICANS followed a similar pattern; patients who developed neurotoxicity had markedly higher peak percentages of CAR T cells within the lymphocyte population than those who did not. These associations reinforce the concept that early, robust expansion drives both therapeutic activity and inflammatory toxicity.

The analysis also examined whether expansion corresponded with treatment response or survival outcomes. Responders tended to have numerically higher expansion peaks, as well as greater overall exposure captured by area-under-the-curve calculations. Although these differences did not reach statistical significance, likely due to sample size, progression-free survival at 6 months was higher among patients whose CAR T expansion exceeded 39% of circulating lymphocytes. This suggests that, at least for axi-cel, rapid expansion in the first week may be more prognostic of benefit than the absolute peak magnitude.

“Although we observed only a trend between CAR T cell expansion and clinical response or survival, our findings suggest that FC monitoring can provide clinically useful insights into CAR T cell–treated patients,” wrote the researchers.

The study is not the first to characterize the relationship between CAR T-cell expansion and response to treatment. For example, a 2023 report detailed how CAR T-cell expansion is linked to both efficacy and side effects related to treatment.²

Beyond the initial expansion window, the study characterized CAR T persistence over the first year.¹ While overall levels declined steadily, a substantial proportion of patients still had detectable CAR T cells at month 6, and a small subset maintained detectable levels at month 12. B-cell aplasia, a pharmacodynamic marker of ongoing CAR T activity, was present in most patients at the 6-month mark. These findings confirm long-term persistence but highlight broad heterogeneity in immune recovery patterns.

Cytopenias were another notable observation. Nearly two-thirds of the patients experienced prolonged cytopenia beyond the first month, most commonly pancytopenia. These patients displayed higher median expansion early after infusion, hinting that an intense inflammatory milieu may disrupt hematopoiesis. Although not statistically significant, the pattern aligns with other reports linking expansion intensity to delayed marrow recovery.

References

1. Zduniak A, Martinet J, Lévêque E, et al. Routine monitoring of CAR-T-cells expansion and persistence in patients with aggressive large B-cell lymphoma by flow cytometry: a single-center experience. Hematol Oncol. Published online October 7, 2025. doi:10.1002/hon.70139

2. Baur K, Buser A, Jeker LT, et al. CD4+ CAR T-cell expansion is associated with response and therapy related toxicities in patients with B-cell lymphomas. Bone Marrow Transplant.