Dr Gibran-Nunes on the Efficacy of Loncastuximab Tesirine in Pretreated DLBCL

“For now, we can state that [loncastuximab tesirine is] a secure drug [that elicits] a good response. It’s a good drug to use as [a treatment] option in these patients.”

Fernando Gibran-Nunes, MD, a hematologist at Hospital Sirio Libanês, discussed findings from a meta-analysis of the use of loncastuximab tesirine-lpyl (Zynlonta) in heavily pretreated patients with diffuse large B-cell lymphoma (DLBCL).

The study focused on the treatment of patients with relapsed/refractory DLBCL, including those who had previously received CAR T-cell therapy. One key takeaway from the pooled analysis of 5 studies involving 556 patients was the consistent overall response rate (ORR) observed across the high-risk subgroups. In the total patient population, the ORR reached 53.23% (95% CI, 38.72%-67.47%). Gibran-Nunes noted that this included a complete response rate of 22.28% (95% CI, 16.21%-28.97%) and a partial response rate of 29.31% (95% CI, 18.98%-40.79%).

A major point of clinical interest was whether loncastuximab tesirine would maintain its efficacy in the post-CAR-T cell therapy population, a group that typically faces a poor prognosis, according to Gibran-Nunes. The meta-analysis confirmed said maintained efficacy, with an ORR of 55.32% (95% CI, 37.85%-72.13%) in this cohort. Furthermore, when stratified by the intensity of prior treatment, patients who had received more than 3 prior lines of therapy achieved a robust ORR of 52.35% (95% CI, 34.27%-70.12%). Treatment discontinuation due to adverse effects occurred in 12.25% (95% CI, 5.18%-21.55%) of patients.

From a statistical perspective, the meta-analysis revealed heterogeneity in the total ORR (P < .0001). However, the test for subgroup differences between patients who had received prior CAR T-cell therapy and those who had not yielded a P value of .2257, indicating that the treatment’s activity was not significantly diminished by prior CAR T-cell therapy exposure.

Looking toward the future of DLBCL management, Gibran-Nunes emphasized that the next critical step is the initiation of randomized controlled trials with comparative arms.