Experts review new Phase 3 DLBCL data, Pola-R-CHP adoption, biomarker testing, and emerging molecular risk groups as bispecific antibodies reshape relapsed care.
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Optimizing Treatment Strategies in Diffuse Large B-Cell Lymphoma
Dr. Jason Westin moderated a comprehensive discussion with Drs. Tara Graff, Patrick Connor Johnson, and Matthew Lunning on the rapidly evolving DLBCL treatment landscape. The program addressed two major positive Phase 3 trials now shaping frontline practice: POLARIX establishing polatuzumab vedotin-R-CHP as a first standard beyond R-CHOP, and the frontMIND trial demonstrating tafasitamab-lenalidomide-R-CHOP superiority across cell-of-origin subtypes and risk groups (IPI 3-5), with over 10% progression-free survival benefit in centrally confirmed patients. Key discussions included treatment sequencing between these enhanced regimens, management of double-hit lymphomas, elderly patient considerations, interim PET and ctDNA interpretation, and the downstream consequences of frontline CD19-directed therapy on subsequent options including anti-CD19 CAR-T cell therapy. The relapsed/refractory landscape section covered the EPCORE DLBCL-1 trial results for epcoritamab, outpatient bispecific antibody administration, bispecific agent differentiation, second-line CAR-T access barriers, CNS prophylaxis strategies, and cost-access considerations. Future directions emphasized frontline bispecific trials and novel-novel combinations.
Optimizing Treatment Strategies in Diffuse Large B-Cell Lymphoma
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Experts review new Phase 3 DLBCL data, Pola-R-CHP adoption, biomarker testing, and emerging molecular risk groups as bispecific antibodies reshape relapsed care.
Dr. Lunning discusses decision-making when both Pola-R-CHP and Tafa-Len-R-CHOP are options.
Dr. Graff addresses whether the absence of overall survival benefit from either POLARIX or frontMIND should discourage adoption.
Dr. Johnson confirms dose-adjusted R-EPOCH as his standard for the vast majority of double-hit patients outside clinical trials, noting POLARIX and frontMIND each included only approximately 6% to 8% double-hit patients, far too few for meaningful subgroup analysis.
Dr. Graff discusses the challenging scenario of a positive interim PET scan mid-treatment.
Dr. Johnson addresses whether using CD19-directed agents in the frontline compromises subsequent relapse options.
Dr. Graff reviews the EPCORE DLBCL-1 Phase 3 trial comparing epcoritamab monotherapy against investigator's choice of R-GemOx or bendamustine-rituximab in relapsed/refractory DLBCL.
Dr. Johnson discusses the FDA's April 2026 update to the epcoritamab label permitting outpatient monitoring for the first full 48 mg dose in relapsed/refractory DLBCL.
Dr. Graff addresses the persistent gap between the CAR-T evidence base and real-world utilization.
Dr. Lunning acknowledges country-specific cost-access realities for novel therapies, noting he prescribes what the evidence supports and then navigates insurance processes including peer-to-peer reviews when needed.
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