Targeting CD19 in Diffuse Large B-Cell Lymphoma - Episode 9
Ali McBride, PharmD, MS, BCPS, BCOP: When we’re looking at patients with diffuse large B-cell lymphoma diagnoses, we often see about an average, just seen in 2019, of about 74,000 patients who were diagnosed with non-Hodgkin lymphoma. In addition, of those patients, around 33% or about one-third of those—usually it’s around 32%—actually have a diagnosis of diffuse large B-cell lymphoma. Putting that into perspective, that’s who we are treating with first-line therapy.
When it comes into the case of relapsed/refractory–based disease states, that’s when we’re seeing patients who may have a potential for a curative-based evaluation who will actually relapse during that period of time. There is a potential for curative diagnostic. However, those patients who are relapsed often have poor prognostic outcome. So they actually may have a higher percentage in terms of relapsing and also in terms of a decreased overall survival as well.
Looking at that picture, really addressing at what the outcomes are, tied with potential options for therapy, we’re limited at this point. So there is clearly a niche for utilization in these patient populations. In fact, 1 of the clear determinants that we have to address up front when we’re looking at the team addressing what potential for therapies there are in that relapsed/refractory setting is going to be the discussion of being transplant eligible and also transplant ineligible.
That really distinguishes what we can do. For patients who are transplant eligible, these patients will then actually go on to a further-treatment-based disease or a regimen for treatment and then go on to an autologous stem cell transplant. In addition, those patients have different options available, some based on their current condition. When we’re taking a look at the transplant-ineligible population, these patients are not able to go to transplant.
They may have higher comorbidities in other areas too. They may be older in age, and we’ll touch upon this a little more, but they have a limited option for treatment. We really have to delve into what they can tolerate, first, and then also what provides the maximal benefit for those patients. Setting up this picture for our patients looking at that relapsed/refractory setting in diffuse large B-cell area, we actually have a limited number of options in some of these transplant-ineligible patient populations.
There have been some new treatment options approved recently. We have seen the utilization of polatuzumab and the combination of bendamustine-rituximab as the backbone showing efficacy. In these cases, we’re utilizing the polatuzumab based on CD79b-based binding, and we do know that about 95% of those B cells do have an expression of that antigen on top.
Having that transmitting membrane domain allows an antibody to bind, thus the polatuzumab can deliver its payload for killing off those cells. That’s the additional utilization here, and it’s very clear in its indication and also outcomes for treatment as well, so the polatuzumab has several benefits in this patient population. We do have to worry about adverse-effect profiles addressing other areas as well. But the outcome has shown a clear evidence of its utilization in this patient population.
We’re looking at a very high potential of utilization of treatment in this patient population. With the PBR [polatuzumab-bendamustine-rituximab], we do have to address several adverse effects. We’ve seen a higher incidence of peripheral neuropathy in these cases, so we do manage those patients appropriately. Also, with the rituximab, for that first-time or second-time infusion reaction we do a great deal of detailing out premedications, making sure we align with our patients to ensure continuous treatment during their period of treatment as well.
We’re always actively looking at or engaging in what that treatment option is based on the outcomes, which are actually relatively good and the PBR [polatuzumab-bendamustine-rituximab] data for treatment the polatuzumab arm, as well as also making sure we mitigate adverse effects for continued treatment, which actually only improves outcomes in these patient populations.
Transcript edited for clarity.