CAR T-Cell Therapy, Targeted Treatments Show Promise in Relapsed DLBCL

Jason Westin, MD, discusses the future of diffuse large B-cell lymphoma treatment.

Jason Westin, MD, director of Lymphoma Clinical Research in the Department of Lymphoma/Myeloma, Division of Cancer Medicine, section chief of Aggressive Lymphoma in Department of Lymphoma/Myeloma, Division of Cancer Medicine, and associate professor in the Department of Lymphoma/Myeloma, Division of Cancer Medicine, at the University of Texas MD Anderson Cancer Center, discusses the future of diffuse large B-cell lymphoma (DLBCL) treatment.

According to Westin, the standard of care for DLBCL hasn’t changed much in the last 20 years. Currently, there are a number of clinical trials in progress to improve the frontline space, but most of the innovation is happening in the relapsed setting. For patients who relapse after rituximab (Rituxan) cyclophosphamide, doxorubicin, vincristine sulfate, and prednisone (R-CHOP), treatment with chimeric antigen receptor (CAR) T-cell therapy is showing promise.

Westin says that in the studies he has be involved with that have used targeted therapy combinations prior to chemotherapy, high response rates have been seen. According to Westin, this may show targeted treatments may work better in newly-diagnosed patients.

0:08 | Well, I'd love to say things will be dramatically different. But we could have said that at any point over the last 20 years and would have been wrong. There are multiple ongoing studies looking at ways to improve the frontline setting. But innovation is more likely in the relapse space, which then filters up to the frontline space. And I think that the CAR T-cell studies showing potential advantages in the second line will change the landscape for patients who have relapsed after R-CHOP in the next 5 to 10 years to favor using CAR T-cell therapy. I think based on having that better cure fraction in the relapse space, more innovation may be possible in the frontline space. And so therefore doing studies that are not handcuffed to the 1970s chemotherapy for fear of not giving a patient the old curative therapy and missing a potential window for cure, I think that will allow us to do more innovative studies. I've done a handful of clinical trials using targeted therapy combinations prior to chemotherapy. And what we've shown in those studies is the response rates are very high. And patients tolerate it very well. And so that's still on a clinical trial stage. But it does show the potential that these targeted treatments can work better in newly diagnosed patients and potentially forego the need for chemotherapy.