Unmet Needs in Diffuse Large B-Cell Lymphoma


Andre H. Goy, MD, and Andrew Ip, MD, offer closing remarks on unmet needs in the treatment of diffuse large B-cell lymphoma.


Andre H. Goy, MD: We cure a very large fraction of patients with large cell lymphoma, and CAR [chimeric antigen receptor] T-cell therapy now cures a fraction of the patients. In large cell lymphoma, we probably cure close to 40% with anti-CD19 CAR T-cell therapy. So as you mentioned, it is important to refer those patients to this option because nothing else cures them in that setting. And now we cannot in large-cell lymphoma because they’re going to progress before they have a donor or an anti-GVL [graft-vs-lymphoma] effect. What are the other unmet needs or opportunities in large cell lymphoma?

Andrew Ip, MD: It almost somewhat mirrors the mantle cell discussion we just had, but there is this problem where we have trouble getting patients to CAR T-cell therapy because either they’re too sick to potentially see the CAR T team or get the leukapheresis, or they don’t even have time to wait 4 to 6 weeks. So the idea of having something more off-the-shelf, and this is more in the bispecific T-cell or BiTE [bispecific T-cell engagers] immunotherapy treatments that are very easy to give; glofitamab is given through an IV [intravenous], epcoritamab is subcutaneous. They both have reasonable efficacy and safety profiles, probably much less CRS [cytokine release syndrome] and neurotoxicity. Certainly, that’s a huge unmet need. Hopefully this year there will be some sort of approvals so we can give some of these drugs as the standard of care rather than trying to enroll patients in trials.

That unmet need of how to treat some of these patients who can’t get the CAR T-cell therapy is still a big thought in my mind. And then I think, in general, for elderly DLBCL [diffuse large B-cell lymphoma] patients it’s still very hard to have a good standard of care because a lot of these patients may not tolerate full-dose R-CHOP [rituximab plus cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone] or definitely not dose-intense treatments. So how do you treat these people in the frontline setting with the most benefits? It could be a combination of maybe giving something like a bispecific up front with some rituximab and a little bit of chemotherapy. Or maybe, I’ve seen some studies look at lenalidomide and bispecific and rituximab. There’s certainly an unmet need on how to treat frontline elderly patients with DLBCL, especially, and I think that’s an active ongoing investigation process.

Andre H. Goy, MD: That was a terrific discussion. I hope our audience can appreciate how subspecialized the John Theurer Cancer Center at Hackensack University Medical Center is. I’m very fortunate to have colleagues like Andrew and others in my division that are very focused on subspecific subsets of lymphomas, which allows us to really go deeper in terms of the expertise, the insight, and better clinical trials as well. We’re very fortunate that our blood cancer program is one of the largest in the region. We have expanded our blood cancer program in South Jersey at the Jersey Shore University Medical Center in Neptune Township, New Jersey with AML [acute myeloid leukemia] and autologous stem cell transplant and CAR T-cell therapy. We also have our colleagues in Georgetown at the Lombardi Comprehensive Cancer Center in Washington, D.C., also with a very strong hematology program.

Altogether, we’re working to try to really develop the next generation of novel therapy in blood cancers. We focused today just on diffuse large-cell lymphoma and mantle cell lymphoma. This is a really exciting time for our patients and our community. I want to thank all our members who participate in a clinic. The terrific nurses, coordinators, research nurses, and first and foremost, my colleague physicians and our colleague pathologists and scientists. We are very much looking forward to the future, and we hope that you enjoyed this session. Have a great day. Thank you.

Transcript edited for clarity.

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