New Alternative in the Treatment of Diffuse Large B-cell Lymphoma
For patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) who are not suitable candidates for autologous stem cell transplantation, a wide range of treatment regimens is available. Recently, the addition of polatuzumab vedotin to rituximab and bendamustine therapy has shown promising efficacy in both registration studies and real-world clinical practice.
Treatment of Patients with Relapsed or Refractory DLBCL
The prognosis for DLBCL patients treated with immunochemotherapy is relatively good, with more than half achieving 10-year survival. Most patients are treated in the 1st line with a combination of rituximab (anti-CD20 antibody) with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Approximately 60% of patients are completely cured with R-CHOP, while about a third relapse on the treatment.
Following relapse, autologous stem cell transplantation (ASCT) is typically used if possible. Patients unable to undergo transplantation are treated with platinum-based immunochemotherapy. Recently, the polatuzumab vedotin (an anti-CD79b antibody-drug conjugate) in combination with rituximab and the alkylating cytostatic bendamustine (pola-BR regimen) has also been registered.
Pola-BR Increases Overall Survival Compared to BR
In the GO29365 registration study, the pola-BR regimen in patients pre-treated with at least one line showed a statistically significant longer median overall survival compared to bendamustine/rituximab therapy (OS: 12.4 vs. 4.4 months; hazard ratio [HR] 0.42; p = 0.0023). The median progression-free survival (PFS) was 7.5 months in the pola-BR group compared to 2 months in the BR group (HR 0.33; p < 0.0001). The safety profile of pola-BR was similar to that of BR.
Data from real-world clinical practice (retrospective studies conducted in Germany and Israel) report a median OS of approximately 7–8 months for the pola-BR regimen. In the Czech Republic, 21 patients received pola-BR within a specific treatment program, achieving an OS of 8.7 months despite having worse baseline characteristics than those in the registration study.
Incorporation of Pola-BR into the Therapeutic Algorithm
The Czech guidelines recommend using platinum-based salvage chemotherapy for relapsed DLBCL patients suitable for stem cell transplantation and proceeding with ASCT once remission is achieved. If patients respond poorly to salvage therapy, gemcitabine-based regimens or pola-BR can be used as a bridge to ASCT or CAR-T cell therapy.
For patients unsuitable for transplantation, pola-BR can be used in the 1st line after relapse, potentially as a bridge to CAR-T cell therapy or in subsequent lines of treatment after relapse on a gemcitabine regimen.
Conclusion
Approximately 10% of DLBCL patients are primarily refractory, with 30–40% relapsing after 1st line treatment. Pola-BR appears to be an effective alternative for patients with relapsed/refractory disease who are not suitable candidates for ASCT. This treatment regimen can also be used as a bridge in preparation for autologous transplantation or CAR-T therapy.
(este)
Source: Trněný M., Janíková A., Procházka V. et al. Polivy – A New Alternative in the Treatment of DLBCL. Hot Topics in Oncology from the Perspective of Czech Doctors 2020; 5 (5): 305–309.
Did you like this article? Would you like to comment on it? Write to us. We are interested in your opinion. We will not publish it, but we will gladly answer you.
