Jennifer L. Crombie, MD, on DLBCL: Real-World Outcomes With Novel Therapies in Relapsed or Refractory Disease
2023 ASCO Annual Meeting
Jennifer L. Crombie, MD, of Dana-Farber Cancer Institute, discusses the historically poor outcomes for patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL). Her study examined real-world data on the use of novel therapies in this population and found that outcomes with second- and third-line regimens of polatuzumab vedotin-piiq plus bendamustine and rituximab and tafasitamab plus lenalidomide remain suboptimal, with worse outcomes particularly after chimeric antigen receptor T-cell therapy (Abstract 7552).
Disclaimer: This video transcript has not been proofread or edited and may contain errors.
Jennifer L. Crombie, MD:
We know that the treatment landscape of diffuse large B-cell lymphoma or DLBCL has significantly evolved over the past few years since the availability of multiple new therapeutic options that are now FDA approved for this disease. The outcomes of patients in the real world setting utilizing these novel agents, however, remains less clearly described. In our study, we utilize the CODA Electronic Health records database, which consists of patient demographic and clinical information from both academic and community practice sites across the United States.
We identified over 5,700 patients with a diagnosis of DLBCL in the database. And further within this cohort, we identified 175 patients with relapsed refractory disease, who had been treated with a novel therapy. Novel therapies consisted of chimeric antigen receptor T-cell therapy, or CAR-T therapy, Tafasitamab plus Lenalidomide, Polatuzumab plus Bendamustine and Rituximab, and along Cetuximab, there were no patients in the database treated with Selinexor.
Patients were also required to have at least one post index response assessment or date of death recorded following their treatment with the novel therapy. Patients were further classified as having received two or more versus three or more lines of therapy. We next examined outcomes within each treatment group. We found that outcomes were best among the patients treated with CAR T-cell therapy with overall response rates of approximately 75% and a median overall survival of 27 in 18 months, in patients who had received two or greater versus three or later lines of therapy.
Outcomes were poorer among patients who had received other novel therapies. Those patients treated with Polatuzumab based regimens had an overall response of approximately 60% and a median overall survival of 7.5 months. And patients treated with Tafasitamab based regimens had response rates ranging from 35 to 40% depending on the line of therapy and a median overall survival of approximately six months.
Patients treated with novel therapies after CAR T-cell had a particularly poor outcomes with overall survivals of less than three months. While it's encouraging that novel therapies are now available for patients with relapse or refractory DLBCL, our data highlight the persistent poor outcomes that are seen in the relapsed refractory setting, particularly after CAR-T relapse and the urgent need for ongoing treatment options in this space. Thankfully, other drugs including CD20, CD3 bispecific antibodies, as well as other novel therapies and combinations are being studied in ongoing clinical trials.
Paula Aristizabal, MD, MAS, of the University of California, San Diego, and Rady Children’s Hospital, talks about using a health systems strengthening approach to improve leukemia care and survival in a public Mexican hospital in the region of the border between the United States and Mexico. The demonstrated increase in overall survival across a decade after implementation of the program seems to validate the use of such models, not only to improve clinical outcomes, but also to build sustainable hospital capacity, financially and organizationally (Abstract 1502).
Arlene O. Siefker-Radtke, MD, of The University of Texas MD Anderson Cancer Center, discusses phase III findings showing that for patients with advanced or metastatic urothelial carcinoma and FGFR alteration who already had been treated with a PD-(L)1 inhibitor, erdafitinib significantly improved overall and progression-free survival, as well as overall response rate, compared with investigator’s choice of chemotherapy (LBA4619).
Bobbie J. Rimel, MD, of Cedars-Sinai Medical Center, and Kathleen N. Moore, MD, of the Stephenson Oklahoma Cancer Center at the University of Oklahoma, discuss phase III results from the MIRASOL trial, which showed that mirvetuximab soravtansine-gynx prolonged overall survival vs investigator’s choice chemotherapy in patients with platinum-resistant ovarian cancer with high folate receptor-alpha expression. The findings suggest a new standard of care for this disease (Abstract LBA5507).
Bobbie J. Rimel, MD, of Cedars-Sinai Medical Center, and Mansoor R. Mirza, MD, of Denmark’s Rigshospitalet and Copenhagen University Hospital, discuss new findings on dostarlimab-gxly plus carboplatin/paclitaxel, which improved progression-free survival while maintaining health-related quality of life, further supporting its use as a standard of care in primary advanced or recurrent endometrial cancer (Abstract 5504).
Carmen E. Guerra, MD, MSCE, of the University of Pennsylvania Abramson Cancer Center, discusses three key abstracts presented at ASCO: strategies to increase accrual of underrepresented populations in Alliance NCTN trials, how patient-clinician education can strengthen partnerships and improve diversity in breast and lung cancer trials, and mediators of racial and ethnic inequities in clinical trial participation among U.S. patients with cancer from 2011 to 2022 (Abstracts 6509, 6510, 6511).