The Evolving Treatment Landscape in Relapsed/Refractory Diffuse Large B-Cell Lymphoma - Episode 5
Ian W. Flinn, MD, PhD: All the regimens we’re talking about are relatively toxic, right? Giving some R-ICE [rituximab-ifosfamide, carboplatin, etoposide] is not for everybody. That probably speaks to the need for newer therapies that are less harsh on patients and more tolerable. Loretta, do you have any thoughts on that? There are some new regimens recently approved, but in general, trying to give people a less toxic therapy with fewer adverse events would certainly be important.
Loretta J. Nastoupil, MD: I 100% agree. Even before I head down that path of choosing my salvage chemotherapy, I have to make a determination regarding whether I think I’m going to cure the patient—that’s going to entail more intensive therapy—or pursue a palliative approach because the toxicities associated with our traditional regimens have been so great. There’s probably a large number of patients who are having fewer of these intensive approaches because we make the determination they’re not going to tolerate it. There was a huge unmet need in terms of having tolerable but effective second-line strategies. What fills that space is tafasitamab and lenalidomide, because the investigators defined the folks they did not feel were suitable for an intensive approach, such as consolidation with high-dose therapy.
More study needs to be done to help us now that we have more options. We need to learn who the optimal candidates are for these less-intensive approaches. But we have treatment options that we didn’t have a year ago.
Ian W. Flinn, MD, PhD: Yes, let’s dive down on that a little, Kami. Last summer there was the approval of the tafasitamab-lenalidomide regimen for patients with previously treated diffuse large B-cell lymphoma. You’ve done a lot of work with this regimen. I was wondering if you could help us understand some of the clinical results and the rationale for the trial.
Kami J. Maddocks, MD: Yes. Tafasitamab is a CD-19 antibody. In a phase 2 study, there were some responses with the single agent in relapsed/refractory diffuse large B-cell lymphoma. The few patients who did respond and achieve a complete response [CR] actually had a fairly long duration of response. That was the rationale for then combining it with lenalidomide.
L-MIND was a phase 2 study that treated 80 patients who, as Loretta mentioned, were considered not eligible for aggressive therapy and autologous stem cell transplant. Patients were treated for a year with combination tafasitamab and lenalidomide. The first 3 months were pretty aggressive. They were treated with weekly infusions, then they were treated bimonthly. After a year, patients were able to go on to maintenance therapy with the antibody tafasitamab alone if they were responding. Overall, the therapy was well tolerated. It’s similar to what you see with lenalidomide in terms of cytopenias, fatigue, rash.
In the phase 2 study there was a 60% overall response rate, with 40% of those patients achieving a complete remission. And in those patients who achieved a CR, the responses were pretty durable. Then in the summer, with longer-term follow-up, we saw that the median duration of response was almost 3 years, which is pretty impressive in this population of patients.
Transcript Edited for Clarity