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How New and Emerging Trends in CAR T-Cell Therapy Can Affect Your Patients

Jason Westin, MD, MS, FACP, director, Lymphoma Clinical Research, section chief, Aggressive Lymphoma, and associate professor, Department of Lymphoma/Myeloma, Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center, discusses challenges with treating patients with large cell lymphoma.

The biggest challenges faced in the treatment of patients with large cell lymphoma are related to the aggressiveness of the disease, explains Westin. Large cell lymphoma is typically diagnosed shortly after it develops, and many patients require urgent therapy.

Patients who respond to treatments will receive 6 cycles of R-CHOP or a modified version of the regimen. For patients who have a suboptimal response to initial treatment with R-CHOP, it is unclear how to proceed, says Westin. In the second-line setting and beyond, treatments for large cell lymphoma are not as effective as first-line treatments in terms of achieving long-term responses, adds Westin. As such, the initial treatments patients receive need to be improved, and clinical trials are the most effective way to do that, concludes Westin.

Jason Westin, MD, MS, FACP, discusses challenges with treating patients with large cell lymphoma.

Dr. Westin on Treatment Challenges in Large Cell Lymphoma

Jason Westin, MD, MS, FACP, director, Lymphoma Clinical Research, section chief, Aggressive Lymphoma, and associate professor, Department of Lymphoma/Myeloma, Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center, discusses the role of rituximab (Rituxan), cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in diffuse large B-cell lymphoma (DLBCL).

R-CHOP has been the standard treatment for patients with DLBCL for many years, says Westin.

Blood tests, CAT scans, and physical examinations can help determine whether a patient is likely to benefit from R-CHOP, says Westin. If a patient is not likely to respond to R-CHOP, alternative treatment options should be considered.

Treatment-related toxicities, such as nausea, fatigue, and neutropenic infections, are fairly common with R-CHOP, and are generally well managed, says Westin. As such, the majority of patients are able to complete the full 6 cycles of R-CHOP, concludes Westin.

Jason Westin, MD, MS, FACP, discusses the role of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone in diffuse large B-cell lymphoma.



Dr. Westin on the Role of R-CHOP in DLBCL

Jason Westin, MD, MS, FACP, director, Lymphoma Clinical Research, section chief, Aggressive Lymphoma, and associate professor, Department of Lymphoma/Myeloma, Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center, discusses the potential for a chemotherapy-free future in large cell lymphoma.

For patients with diffuse large B-cell lymphoma, one option in the frontline setting is to modify the chemotherapy, says Westin. Dose-adjusted rituximab (Rituxan), etoposide phosphate, prednisone, vincristine sulfate, cyclophosphamide, and doxorubicin hydrochloride (R-EPOCH) is a modified version of rituximab (Rituxan), cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), explains Westin. The combination of hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper-CVAD) or cyclophosphamide, vincristine, doxorubicin, high-dose methotrexate (CODOX-M) are also modified versions of R-CHOP, which are all largely based on 1970s chemotherapy.

Multiple attempts to add targeted agents to R-CHOP have been made, says Westin; however, this approach has failed because the chemotherapy drugs do not synergize well with new targeted agents. At The University of Texas MD Anderson Cancer Center, multiple clinical trials are evaluating the combination of targeted agents for newly diagnosed patients with large cell lymphoma, and response rates above 80% are being observed without any chemotherapy. The data are still immature and require more follow-up, but there is potential for a chemotherapy-free future for large cell lymphoma, concludes Westin.

Jason Westin, MD, MS, FACP, discusses the potential for a chemotherapy-free future in large cell lymphoma.

Jason Westin, MD, MS, FACP, MD Anderson Cancer Center

Articles

How New and Emerging Trends in CAR T-Cell Therapy Can Affect Your Patients

Dr. Westin on Treatment Challenges in Large Cell Lymphoma

Dr. Westin on the Role of R-CHOP in DLBCL

Dr. Westin on Potential for Chemo-Free Treatment in Large Cell Lymphoma