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Dr Tycel Phillips on the Need for Novel Therapies for DLBCL


Tycel Phillips, MD, hematologist-oncologist at City of Hope in Duarte, California, discusses the need for novel treatments for patients with diffuse large B-cell lymphoma (DLBCL).

Tycel Phillips, MD, associate professor of medicine in the Division of Lymphoma and Bone Marrow Transplantation at City of Hope in Duarte, California, discusses the need for novel treatments for patients with diffuse large B-cell lymphoma (DLBCL).


Despite recent advances, what unmet needs exist for patients with DLBCL?

For one, the approvement of CAR T [chimeric antigen receptor T-cell therapy] has been a great step for the management of patients with diffuse large B-cell lymphoma. But I think we're all continually aware of the access issues we have with CAR T treatment, which does sometimes limit the amount of patients who can actually get the CAR T. I think as we look at it, only about 30% of patients who should be eligible for CAR T actually receive CAR T, and I think a lot of that may be regionally based, as you have quite a few CAR T centers on the east and west coasts but not as many within the majority of the rest of the continental US. For those patients, the options that we have currently are a bit limited. We are left with loncastuximab, which is a CD19 drug antibody conjugate, and then we have lenalidomide and tafasitamab which is a combination, and then we have polatuzamab, and bendamustine plus rituximab. And now with this last one, bendamustine plus polatuzamab, with the recent approval of polatuzamab in the frontline setting based on the POLARIX study, that does call into question whether that's actually going to be an option for the relapsed or refractory patients. So, in essence, we're sort of looking at two agents, both targeting CD19, one being a CD19 drug antibody conjugate—meaning an antibody with a drug attached to it—and the other one being a drug that we have with typically given with lenalidomide.

Overall, for those patients, which I mean, you would think about as part of 30,000 diffuse large B-cell lymphoma patients diagnosed each year, about two-thirds of those patients will probably be cured with initial therapy. But we do have diminishing returns with each subsequent line of therapy for those relapsed or refractory patients. And even with CAR T, we’re probably only curing 30% to 40% of those patients. So, again, there are a quite a few patients who will probably benefit from having more novel therapies. And as I mentioned, with the 2 main ones that we have currently, I mean, we do have some longer term data with lenalidomide and tafasitamab. But for the most part, the patients that we typically see the most are refractory patients, [and] a lot of those patients were not included in the dataset from that original study. So, more treatments that specifically have data in patients with primary refractory disease are needed.

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