Targeting CD19 in Diffuse Large B-Cell Lymphoma - Episode 5

L-MIND Combination Therapy Dosing Schedule

May 7, 2020
Targeted Oncology

Ian Flinn, MD: We talked a little bit about some of the adverse events, some of the cytopenias that can occur. And the fact that the antibody is pretty well tolerated from an infusion standpoint. That’s impressive in the setting that this therapy goes on—this combination therapy goes on for a year. And then patients can drop off of the lenalidomide and remain on MOR208, a novel Fc-enhanced CD19-targeted antibody.

John, based on other antibody approaches and R-squared [Revlimid and Rituximab], which is probably the closest equivalent that we can come up with here, is that how you would approach it? Do you think you would just continue on with the lenalidomide? Or what do you think about that?

John Pagel, MD, PhD: That’s a great question. Certainly lenalidomide is, for most patients, relatively well tolerated, but, not for everybody. There are certainly risks for deep venous thromboses. We don’t see that often—if we can kind of prophylax with aspirin use in the majority of patients. In general, though, what I would say is if people are doing well, it’s a judgment call at the time that that year is up.

More importantly, for me, I would say it’s the continuing of the antibody treatment. And you can argue that all of this therapy, as long as you can possibly deliver it, is valuable for a patient who might not have other treatment options or may actually be significantly benefitting for long periods of time. I don’t know the right answer there. I mean, I suspect you and I might see the same patient and approach it a little bit differently. For me in general, I’m probably going to stop the lenalidomide every year. I hope that I don’t get burned with that. How about you, what are your thoughts?

Ian Flinn, MD: Yeah, I think I probably would too, until, you know, I think we need a little bit more details of the study still to come out in terms of what does the shape of the curve look like? Is there a sudden drop-off at the point where you stop lenalidomide? If that did, then I might continue with it. On the other hand, and I guess if someone was tolerating it well, it might make you want to at least open up the option of continuing. Otherwise, I tend to do it just like they did in the clinical trial.

John Pagel, MD, PhD: Yeah, I do, too.

Transcript edited for clarity.