Targeting CD19 in Diffuse Large B-Cell Lymphoma - Episode 13

Future Directions for R/R DLBCL

May 7, 2020
Targeted Oncology

Ali McBride, PharmD, MS, BCPS, BCOP: Looking at current treatments available for those patients with refractory disease in diffuse large B-cell lymphoma, 1 of the options that comes up is looking at tafasitamab as a bridging or a potential salvage pathway prior to CAR [chimeric antigen receptor] T-cell therapy. In a study that was done, 1 patient did go on to CAR T afterward.

That really brings into light the question: Will this be used as a bridging pathway again and go into CAR T for patients who may not be eligible, therefore allowing patients who initially may not have been eligible to now be eligible. Actually, that was seen with not only CAR T, but patients went on to autologous CAR T and allogeneic CAR T based on L-MIND study as well. That really set up a patient to have a potentially better outcome from treatment addition to it.

That that allows patients to go on to CAR T or a transplant as well thereafter. That does mitigate some of those early discussions about transplant-ineligible patients if we’re utilizing this therapy. It provides an option for other available treatments thereafter. That’s a unique setting. Again, this was a small patient population that was seen again as a 1-off in the CAR T discussion. But as we started to see more of this being utilized once approved, that will then only allow increased access to a therapy if we can convert some of those patients to be transplant eligible in the situation as well.

That sets up a very good discussion in the future for how this therapy can be utilized with other therapies in terms of a sequencing format. Moving on to these discussions about how tafasitamab is going to change the market for our patients in the non-Hodgkin lymphoma setting, the diffuse large B-cell setting, is looking at the evolution of new studies coming on board. We know the B-MIND is being looked at.

We’ve seen discussions and also the utilization of the R-CHOP [rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone] or the combination of the R-CHOP [rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone] as well early on for frontline setting. So we may see this utilized with other combination therapies as the number of clinical trials increases with this therapy. Also, the discussion on first-line utilization will be critical. That will only add to the discussion about available options. Looking more toward the future, as we start to see the evolution of this product and other combination therapies, that will actually allude to an increased optional resource for our patients in the frontline setting—which may not have been an option early on—and also in other lines of therapy as well. This is promoting how we can utilize CD19 therapies, not just a distinctive CAR T therapy—which is just actually what you’re looking at from a CAR T standpoint based on the 2 available options—but also tafasitamab as well. This is really going to change the paradigm treatment and change the option numbers, but also maybe look at pathways for development on what promotes the best outcomes for treatment as well.

Transcript edited for clarity.