Dr Mehta on FDA-Approved Treatment Options in Later-Line Hematologic Malignancies

Amitkumar Mehta, MD, associate professor of medicine, associate director, Hematology and Oncology Fellowship Program, director, Phase I Program, co-director, CAR-T Program, University of Alabama at Birmingham (UAB) Bone Marrow Transplant Program, co-director, Cutaneous T Cell Lymphoma Clinic, The Kirkin Clinic, director and principal investigator, Lymphoma Tissue Bank, and director, UAB Lymphoma Working Group, UAB Medicine, discusses FDA-approved treatment options for patients with diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma in later lines.

There are 2 FDA-approved agents for diffuse large B-cell lymphoma (DLBCL) in the third-line setting: glofitamab-gxbm (Columvi) and epcoritamab-bysp (Epkinly), Mehta begins. Both therapies have shown efficacy for patients who have progressed after 2 prior lines of treatment, he explains. In follicular lymphoma, both epcoritamab and mosunetuzumab-axgb (Lunsumio) received FDA approval for use in later-line treatment settings, Mehta notes. Historically, patients who have progressed on at least 2 lines of conventional chemoimmunotherapy face poor outcomes. Retrospective studies, such as the SCHOLAR-1 study, provide a benchmark for evaluating new therapies in these populations, he reports. Mehta adds that both glofitamab and epcoritamab have demonstrated promising efficacy when compared with historical standards.

CAR T-cell therapies have not yet been directly compared with bispecific antibodies like glofitamab or epcoritamab in head-to-head clinical trials, Mehta continues. However, both CAR T-cell therapies and bispecific antibodies have significantly improved patient outcomes compared with conventional chemoimmunotherapy.

In follicular lymphoma, the third-line treatment paradigm has undergone several shifts, he expands. PI3K inhibitors, which were once considered a viable option in this setting, have since been withdrawn due to their associated adverse effects, particularly infections. Consequently, CAR T-cell therapies and mosunetuzumab have become critical treatment alternatives for patients with this disease, generating high overall response rates and progression-free survival benefit, Mehta emphasizes.

Notable differences between these agents exist. CAR T-cell therapy typically requires inpatient admission due to its complexity and cost, whereas bispecific antibodies are often administered in an outpatient setting, he states. Despite these distinctions, both approaches have led to significant improvements in patient outcomes compared to the historical benchmarks in later-line settings, Mehta concludes.