CAR-T Meeting 2023 | Treatment options for patients with DLBCL who relapse after CAR-T therapy

For patients who relapse after CAR-T therapy, we often want to try and think about a clinical trial that’s these patients are high risk, they’ve got obviously very refractory disease. So I’m always very keen to look at what clinical trial options we have available.

We do have other licensed therapies. We currently have licensed rituximab, bendamustine, polatuzumab for auto-ineligible patients, second-line and beyond. There is a license and it’s going through NICE at the minute about tafasitamab-lenalidomide. And tafasitamab is an anti-CD19 naked antibody which is used in combination with lenalidomide and the tafa is continued until progression.

So this can be used in countries where there is reimbursement, and I’m waiting to hear from NICE, as to whether this could be an option for our patients. And then other licensed therapies, again, not reimbursed in the UK, but going to go through NICE is loncastuximab, which currently has a licensed third-line and beyond.

So, we do have other options available for these patients who are considered to be not auto-eligible. But we do need to think about clinical trials. And the clinical trials that I’m quite excited about is the bispecific antibodies and we have many bispecific antibodies in a clinical trial at present, and none of them as yet have license, but this may be an option for patients, and certainly, CAR-T patients aren’t excluded for many of these trials.

So, understanding sequencing of these therapies is going to be really important, because when we have more therapies to choose from, we know that the impact of one therapy may impact the efficacy of the subsequent one. So, I think it’s going to be really important that we collect real-world data so that we can really understand the optimal sequencing, so that we really carefully choose the sequence for our patients.