ICML 2025 | Moving away from chemotherapy-based approaches in R/R DLBCL: the impact of immunotherapies

I think in the relapsed setting, we have already attained a situation where I can safely tell most of my patients that there will not be any more chemotherapy coming for them. Both in diffuse large B-cell lymphoma, most treatments for the relapsed setting now involve either immunotherapies or molecularly targeted agents, CAR T-cells certainly, but also in indolent lymphomas we use more and more non-chemotherapy approaches. There are lingering chemotherapy-based treatments entrenched in the treatment of diffuse large B-cell lymphoma and indolent lymphomas as well. And I really hope that this will change in the next five, ten years. I think people are getting warmed up to the idea that anthracycline chemotherapy may not be necessary for curing a significant proportion of patients with diffuse large B-cell lymphoma and as these drugs in combinations become more often used in refractory settings and this will trickle down to the first line setting as well. And we already had first glimpses of the future. We conducted a trial of mosunetuzumab with polatuzumab, completely immune-based therapy combination for first-line diffuse large B-cell lymphoma which provided a complete response to almost 66% of patients or two-thirds of patients and I believe this could be sustained with additional combinations and hopefully in indolent lymphomas the bendamustine-based chemotherapy will also slowly go away as our immunotherapies and molecularly targeted agents become available in first-line setting.

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