R/R DLBCL – Novel Treatments & Clinical Experiences
Nearly two-thirds of patients with newly diagnosed DLBCL are cured with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) therapy. A minority of those with relapsed disease are candidates for salvage chemotherapy followed by high dose therapy and autologous stem cell transplant (ASCT), however few attain long-term remission. Moreover, those with refractory disease have a median survival of 6 months, which presents a dire need for improved treatments in patients with this deadly presentation.
The emergence of new targeted agents and immunotherapies represents a sea change in the treatment landscape for B-cell lymphomas. Approvals of CAR T-cell therapy, the anti-CD19 monoclonal antibody tafasitamab (Monjuvi), and the antibody-drug conjugate polatuzumab (Polivy) now bring effective treatment options to those with relapsed/refractory disease. Tafasitamab is an Fc-enhanced, anti-CD19 monoclonal antibody that has exhibited single-agent activity in patients with relapsed or refractory B-cell malignancies. It is suggested to act synergistically with lenalidomide (Revlimid), and the immunotherapy dyad of tafasitamab and lenalidomide became the first FDA-approved therapy as second-line treatment of DLBCL. In the Phase II L-MIND study, 80 patients with relapsed/refractory DLBCL who were unsuitable for ASCT, attained an overall response rate (ORR) of 60%, and 43% of patients attained a complete response with a median duration of response 21.7 months and a median progression-free survival (PFS) of 12.1 months. Notably, median overall survival (OS) was not reached. Researchers observed responses in patients with both germinal center and nongerminal center DLBCL and the combination was found to be well tolerated.
What are your experiences with these novel treatments for DLBCL?
How do you advise your patients on prognosis and other concerns related to these novel treatments?