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Study Examines Real-World Outcomes of Novel Treatments for Diffuse Large B-Cell Lymphoma
Recent work by Jennifer Leigh Crombie, MD, Dana-Farber Cancer Institute, Boston, MA, and colleagues analyzed the clinical outcomes for patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) who received novel treatments, including chimeric antigen receptor T-cell (CAR T), polatuzumab vedotin plus bendamustine and rituximab (pola-BR), and tafasitamab plus lenalidomide (tafa-len). They presented their findings in an abstract at the 2023 ASCO Annual Meeting in Chicago, IL.
The authors used information from the COTA electronic health records database and included patients who were diagnosed with DLBCL after January 1, 2010; had ≥1 prior line of systemic antineoplastic therapy; and were treated with CAR T, pola-BR (or variaations), tafa-len (or variations), loncastuximab (lonca), and/or selinexor. They evaluated overall response rate (ORR), complete response (CR) rate, median progression-free survival (mPFS), and median overall survival (mOS), with a subanalysis of patients who received a novel therapy after CAR-T treatment.
Of the 175 patients with R/R DLBCL included in the study, 61.7% had stage III/IV disease and 65.7% had primary refractory disease. For the treatments, 73 patients received CAR T, 69 received pola-BR, 27 received tafa-len, 6 received Ionca, and 0 received selinexor regimens. Overall, outcome measures for CAR T in the second-line or later setting, which included 169 patients, were higher (CR, 52.1%; ORR, 76.7%; mPFS, 6.7 mo; mOS, 26.5 mo) compared to pola-BR (CR, 18.8%; ORR, 59.4%; mPFS, 3.1 mo; mOS, 7.8 mo) or tafa-len (CR, 11.1%; ORR, 40.7%; mPFS, 1.9 mo; mOS, 6.3 mo). This also held true in the third-line or later setting, which included 112 patients in the analysis (CAR T: CR, 41.8%; ORR, 74.6%; mPFS, 5.6 mo; 17.8 mo. Pola-BR: CR, 13.5%; ORR, 62.2%; mPFS, 3.4 mo; mOS, 7.4 mo. Tafa-len: CR, 10.0%; ORR, 35.0%; mPFS, 1.7 mo; mOS, 6.3 mo).
For the subanalysis, 18% of patients received novel therapies after receiving CAR T, and they had worse outcomes overall (CR, 4.8%; ORR, 19.1%; mPFS, 1.4 mo; mOS 2.3 mo).
Dr Crombie and colleagues noted that in their study, the outcomes for patients with R/R DLBCL worsened as they advanced through lines of therapy. Pola-BR and tafa-len underperformed compared to CAR T in the second-line-plus and third-line-plus settings, and all the evaluated novel agents performed more poorly when used after CAR-T therapy.
Source:
Crombie JL, Jun MP, Wang T, et al. Real-world outcomes with novel therapies in R/R DLBCL. Presented at the 2023 ASCO Annual Meeting; June 2-6, 2023; Chicago, IL, and virtual; Abstract 7552.
