A 76-Year-Old Man with Relapsed DLBCL - Episode 4
A key opinion leader reviews novel therapies for diffuse large B-cell lymphoma.
Laurie Sehn, MD: What are some of the downsides of this treatment? Of course, there’s no treatment that doesn’t come with some toxicity associated with it. Many of us are familiar with the toxicities of bendamustine and rituximab because it’s a combination we routinely use for many of our patients, particularly those with indolent lymphoma. When you add polatuzumab vedotin to BR [bendamustine, rituximab], there’s a bit of a step up in toxicity. We saw a higher rate of neutropenia associated with the triple combination, although it didn’t translate into a higher risk of infection compared with patients receiving BR [bendamustine, rituximab].
Polatuzumab vedotin can be associated with peripheral neuropathy. Similar to what we see with brentuximab vedotin, there’s a cumulative peripheral neuropathy that can occur. The more treatment patients get, the more likely it is that you may see it in your own patients. Importantly, this is a treatment that’s just based on 6 cycles. With 6 cycles of treatment, for those patients who experience peripheral neuropathy, it was largely low grade and reversible.
What about some other treatment options for this patient? There are other novel therapies in development. The combination of tafasitamab and lenalidomide has also earned FDA approval and is listed in the NCCN [National Comprehensive Cancer Network] Guidelines as an approved therapy for relapsed/refractory DLBCL [diffuse large B-cell lymphoma]. This combination is aiming to induce an immunotherapy with the tafasitamab being an anti-CD19 monoclonal antibody. It’s similar to rituximab, although targeting a different cell surface marker. And then lenalidomide is an immunomodulatory agent. It also likely has some other aspects regarding its mechanism of action. This is a combination that has also shown promise in relapsed/refractory DLBCL and is now accessible as well.
However, in the clinical trial that was performed, patients with primary refractory disease were initially excluded. The majority of patients on the phase 2 trial that earned it its regulatory approval would have had relapsed disease and were perhaps a slightly better-risk group of patients with relapsed/refractory disease. We’ll have to learn as we gain more experience in clinical practice what it might achieve for the primary refractory patient. But for this patient with primary refractory disease who we’ve been discussing, polatuzumab–BR [bendamustine, rituximab] was an excellent option for him as a next step.
This transcript has been edited for clarity.
Case Overview: A 76-Year-Old Man with R/R DLBCL