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.

Related Videos


Sarah K. Tasian, MD, on Hematologic Malignancies in Children: Expert Commentary

Sarah K. Tasian, MD, of Children’s Hospital of Philadelphia, summarizes three studies presented at ASCO: genomic determinants of outcome in acute lymphoblastic leukemia (ALL), a phase III trial of inotuzumab ozogamicin for high-risk B-cell ALL, and preliminary results from the first-in-child phase II trial of bosutinib in pediatric patients with newly diagnosed chronic myeloid leukemia (Abstracts 10015, 10016, and 10017).

Lung Cancer

Nagla Abdel Karim, MD, on Small Cell Lung Cancer: SWOG S1929 Results on Atezolizumab Plus Talazoparib

Nagla Abdel Karim, MD, of the Inova Schar Cancer Institute, University of Virginia, discusses phase II data showing that maintenance atezolizumab plus talazoparib improved progression-free survival in Schlafen-11–selected patients with extensive-stage small cell lung cancer. This study demonstrated the feasibility of conducting biomarker-selected trials in this disease, paving the way for future evaluation of novel therapies in selected populations (Abstract 8504).

Lung Cancer

Narjust Florez, MD, and Filippo Gustavo Dall’Olio, MD, on NSCLC: New Findings on Tumor Fraction, Durvalumab, and Survival

Narjust Florez, MD, of Dana-Farber Cancer Institute, and Filippo Gustavo Dall’Olio, MD, of Institut Gustave Roussy, discuss circulating tumor DNA tumor fraction, and its link to survival in patients with advanced non–small cell lung cancer (NSCLC) treated with maintenance durvalumab in the UNICANCER SAFIR02-Lung/IFCT1301 trial. Tumor fraction was positive in 16% of patients randomly assigned to receive durvalumab in the study. This population seems to have a limited benefit from maintenance durvalumab after induction chemotherapy (Abstract 2516).

Solid Tumors

Funda Meric-Bernstam, MD, on HER2-Expressing Solid Tumors: Efficacy and Safety of Trastuzumab Deruxtecan

Funda Meric-Bernstam, MD, of The University of Texas MD Anderson Cancer Center, discusses interim results from the DESTINY-PanTumor02 trial, the first tumor-agnostic global study of fam-trastuzumab deruxtecan-nxki (T-DXd) in a broad range of HER2-expressing solid tumors. This agent showed an encouraging overall response rate, particularly in patients with IHC 3+ expression; durable clinical benefit; and a manageable safety profile in these heavily pretreated patients. T-DXd may be a potential new treatment option for this population (Abstract LBA3000).

Lung Cancer

Jonathan W. Riess, MD, on EGFR-Mutated Non–Small Cell Lung Cancer: What’s Next?

Jonathan W. Riess, MD, of the University of California, Davis Comprehensive Cancer Center, explores the findings of three important clinical trials in lung cancer treatment: whether to incorporate immune checkpoint inhibitors into the treatment of EGFR-mutated lung cancer, the importance of central nervous system activity in EGFR-mutant lung cancer, and new therapies for disease with EGFR exon 20 insertion.