Positioning Bispecific Antibodies and Combinations in DLBCL Treatment

Dr. Chavez explains that for most patients with relapsed/refractory DLBCL in the third-line setting, including those who are not CAR T candidates, decline CAR T, or progress after CAR T, bispecific antibodies are his preferred option. He notes that institutional experience managing CRS in the CAR T era supports broader use, including in the community. The physicians discuss emerging combinations, including glofitamab or epcoritamab with gemcitabine and oxaliplatin, mosunetuzumab with polatuzumab vedotin, and loncastuximab tesirine-based regimens, which may improve efficacy and reduce CRS, though cytopenias can require growth factor support. Dr. Chavez notes that some combinations are used in the second line based on STARGLO and SUNMO data and NCCN compendium listings, despite lacking FDA approval in that setting. Dr. Phillips describes monitoring immunoglobulin levels, including IgG subtypes, and CMV. The physicians close with key takeaways for community oncologists.