Key Strategies and Perspectives: How Novel 2nd-Line Therapy Options May Impact 3rd-Line Treatment Landscape in R/R FL and Bridging Strategies to CAR T
Panelists discuss how bridging therapies, including chemotherapy, targeted therapies, immunotherapy, and steroids, are used to control disease progression in patients awaiting CAR T therapy, with the choice of treatment depending on disease type, performance status, and the urgency of disease control.
Summary for Physicians:
For patients who are eligible for CAR T therapy, bridging therapy is often required, particularly in those with rapidly progressing disease or high tumor burden. The goal of bridging therapy is to control disease progression while the patient is waiting for CAR T-cell manufacturing, which can take a few weeks.
The typical bridging strategy involves using short-term therapies that are effective in controlling disease without interfering with the planned CAR T treatment. Common approaches include the following:
- Chemotherapy: Agents such as rituximab or bendamustine may be used as bridging therapies, providing a quick response to stabilize the disease before CAR T infusion.
- Targeted therapies: For certain patients, Bruton tyrosine kinase inhibitors (such as ibrutinib or acalabrutinib) can be utilized as bridging therapy, especially for those with chronic lymphocytic leukemia or mantle cell lymphoma.
- Immunotherapy: Rituximab alone or in combination with other therapies may be used for patients with CD20-positive diseases such as follicular lymphoma or diffuse large B-cell lymphoma.
- Steroids: In some cases, low-dose steroids are used to control disease-related symptoms or inflammation during the bridging period.
The choice of bridging therapy depends on the patient’s disease type, performance status, and the urgency of controlling disease progression. The key is to maintain disease control without causing significant toxicity that could hinder the efficacy of CAR T therapy once administered.
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