Tycel Phillips, MD, discusses the agents available for the second-line treatment of diffuse large B-cell lymphoma, and the utility of chimeric antigen receptor T-cell therapy.
Tycel Phillips, MD, associate professor, Division of Lymphoma, Department of Hematology & Hematopoietic Cell Transplantation, discusses treatment options for diffuse large B-cell lymphoma in the Unites States [US].
0:08 | At the current moment, if we look at patients with relapsed refractory diffuse large B cell lymphoma, which is the most common non-Hodgkin lymphoma in the US in that setting, we had several approved agents in the last several years. So, there was an oral medication lenalidomide [Revlimid] given together with an antibody called tafasitamab, and that is approved for patients [in] second-line or beyond, especially those in second-line who are unable to tolerate more traditional treatments. In that second-line space, we have historically had salvage chemotherapy, and the complications that we know come with that, followed by autologous stem cell transplantation. For a large number of patients, salvage chemo and autologous transplant was not a great option because these patients had intrinsic resistance to chemotherapy.
1:00 | More recently, we had the approval of 2 chimeric antigen receptor therapy treatments, or CAR T treatment. CAR T, as much as we advocate for it, is also available in the third-line is underutilized here in the US with only about a third of patients who are eligible for CAR T, or making it to CAR T. So, there's a large number of patients who cannot get to this treatment either because they do not live near a CAR T center or they don't want to travel to a CAR T center, or they can't keep their disease under control enough to get to CAR T.
1:29 | As of right now, CAR T is probably the only treatment that has durable responses in this patient population. So, with those other treatments that I didn't mention, there's probably a minority of those patients who will have a durable response. But the vast majority of those patients will likely relapse and die from the cancer, and if they can't get the CAR Tt that does leave a large number of patients who are at need, which prompts the need for more treatments in his patient population. Because even with CAR T, as much as I have advocated for have in this you know earlier in this conversation, about half of those patients, if not a little bit more, will fail to respond to CAR T or relapse after treatment with CAR T, and those patients have very poor outcomes as well.