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Treatment Options for Relapsed/Refractory Diffuse Large B-Cell Lymphoma

Andre Goy, MD, MS, chief, Division of Lymphoma, chairman and director, John Theurer Cancer Center, discusses updates in CAR T-cell therapy that are being presented at the 2019 ASCO Annual Meeting.

Many of the studies presented at the 2019 ASCO Annual Meeting related to CAR T-cell therapy were trials in progress. However, one study that had data read out included a subset from the ZUMA-1 trial, which demonstrated promising efficacy and safety data in patients older than 65 years with axicabtagene ciloleucel (Yescarta). Moreover, in the TRANSCEND NHL 001 trial,  lisocabtagene maraleucel, another CAR T-cell product, also demonstrated benefit in patients with relapsed/refractory mantle cell lymphoma. 

In patients with relapsed/refractory central nervous system lymphoma, data also showed that CAR T-cell therapy is feasible and demonstrated preliminary activity. 

Dr. Goy on CAR T-Cell Therapy Updates in Non-Hodgkin Lymphoma

Andre Goy, MD, MS, chief, Division of Lymphoma, chairman and director, John Theurer Cancer Center, discusses promising data with acalabrutinib (Calquence) in the treatment of patients with mantle cell lymphoma (MCL).

At the 2018 ASH Annual Meeting, Goy says there was an explosion of exciting data with small molecule inhibitors across the different hematologic malignancies. This holds true in MCL, where recent clinical trials have been attempting to shy away from the use of traditional cytotoxic chemotherapy in these patients. In the relapsed/refractory setting, BTK inhibitors are starting to rise to the forefront, and researchers presented long-term follow-up data with the second-generation inhibitor acalabrutinib at the meeting. This drug differs from the first-generation inhibitor ibrutinib (Imbruvica) in that there appears to be less off-target effects and less cardiotoxicity, if any.

At a follow-up of over 2 years, results showed a median duration of response with acalabrutinib of over 26 months with an overall response rate of over 80%. The complete response rate to the agent was approximately 60%, Goy says, which was really exciting. This efficacy and tolerability makes acalabrutinib a good candidate to combine with other small molecule drugs, he adds.

Andre Goy, MD, MS, chief, Division of Lymphoma, chairman and director, John Theurer Cancer Center, discusses promising data with acalabrutinib in the treatment of patients with mantle cell lymphoma.

Dr. Goy on Promising Data With Acalabrutinib in MCL

Andre Goy, MD, MS, chief, Division of Lymphoma, chairman and director, John Theurer Cancer Center, discusses the potential of immunotherapy in patients with mantle cell lymphoma (MCL).

Lenalidomide (Revlimid) and rituximab (Rituxan; R2) plus ibrutinib (Imbruvica) is a combination approach of immunotherapy and targeted therapy, explains Goy. At John Theurer Cancer Center, 71% of heavily pretreated patients with MCL experienced a complete response with the regimen. Additionally, a published study showed high response rates in patients with poor genetic risk factors.

Traditionally, when physicians think about immunotherapy, they think about chimeric antigen receptor T cells, says Goy. However, a lot remains unknown about the use of checkpoint inhibitors in MCL. Activity outside of primary mediastinal lymphoma and Hodgkin lymphoma has been relatively disappointing, explains Goy. However, there is a lot of potential with anti—CD47 antibodies that may enable physicians to give patients a biological induction, and subsequently consider immunotherapy in high-risk patients.

Author | Andre Goy, MD, John Theurer Cancer Center

Articles

Treatment Options for Relapsed/Refractory Diffuse Large B-Cell Lymphoma

Dr. Goy on CAR T-Cell Therapy Updates in Non-Hodgkin Lymphoma

Dr. Goy on Promising Data With Acalabrutinib in MCL

Dr. Goy on Immunotherapy in Mantle Cell Lymphoma