Fast-Moving Treatment Advances Shape B-Cell Lymphoma Care

In this episode of Oncology Unplugged, host Chandler Park, MD, a medical oncologist at Norton Cancer Institute in Louisville, Kentucky, was joined by Joshua Brody, MD, the director of the Lymphoma Immunotherapy Program at the Mount Sinai Tisch Cancer Center and a faculty member of the Icahn Genomics Institute in New York, New York.

Their discussion centered on the rapidly evolving treatment landscape for B-cell non-Hodgkin lymphomas, highlighting a wave of recent advances across frontline and relapsed diffuse large B-cell lymphoma (DLBCL) and mantle cell lymphoma (MCL) management. Drs Park and Brody framed this current era as one of unusually fast progress after decades of failed attempts to improve upon R-CHOP (rituximab [Rituxan], cyclophosphamide, doxorubicin, vincristine, and prednisone).

A major focus was the phase 3 frontMIND trial (NCT04824092), which added tafasitamab-cxix (Monjuvi) and lenalidomide (Revlimid) to R-CHOP in patients with frontline DLBCL. Dr Brody discussed the significant progression-free survival benefit with the experimental combination that extended across patient subgroups rather than being confined to patients with activated B-cell–like or non–germinal center disease, with only a modest increase in the rate of high-grade febrile neutropenia. He contextualized this against earlier trials in the DLBCL space.

The discussion then turned to relapsed disease, where Dr Brody described the benefits of CAR T-cell therapy over stem cell transplant and reviewed bispecific antibody/chemotherapy combinations, including glofitamab-gxbm (Columvi) and epcoritamab-bysp (Epkinly) plus gemcitabine and oxaliplatin. He also emphasized the importance of clinical trials.

Drs Park and Brody also explored the evolving MCL treatment paradigm, highlighting glofitamab's complete remission rate and the FDA approval of the BCL-2 inhibitor sonrotoclax (Beqalzi), alongside strategies to mitigate cytokine release syndrome and tumor lysis syndrome. The conversation concluded with a look at emerging therapies, including CD19-directed bispecific antibodies and in vivo CAR T-cell therapy delivered via viral and mRNA lipid nanoparticle vectors.