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ICML 2025 | The potential of bispecific antibodies in secondary CNS lymphoma: a retrospective study
Nikita Dave, MD, University of Pennsylvania, Philadelphia, PA, comments on the potential of bispecifics in treating secondary central nervous system (CNS) lymphoma. Dr Dave notes that these patients have historically been excluded from trials, but a retrospective study shows high response rates and low rates of toxicity. This interview took place during the 18th International Conference on Malignant Lymphoma (18-ICML) in Lugano, Switzerland.
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Transcript
Yeah, so I’m really excited about bispecifics in CNS lymphoma. As you probably know, they were approved in 2023 for systemic lymphoma, in particular, glofitamab, epcoritamab, and mosunetuzumab. And there have been pretty good responses so far. But the initial trials, unfortunately, excluded patients with CNS lymphoma. You can imagine, glofitamab, for example, is quite a big antibody...
Yeah, so I’m really excited about bispecifics in CNS lymphoma. As you probably know, they were approved in 2023 for systemic lymphoma, in particular, glofitamab, epcoritamab, and mosunetuzumab. And there have been pretty good responses so far. But the initial trials, unfortunately, excluded patients with CNS lymphoma. You can imagine, glofitamab, for example, is quite a big antibody. It actually has two FC regions, and it’s about 250 kilodaltons. So there were some concerns that it wouldn’t in particular penetrate the CSF. So they actually excluded these patients. So we didn’t know whether or not bispecifics penetrated the CSF. There was a really interesting paper in the summer of last year from City of Hope, where they actually looked at four patients who got glofitamab for secondary CNS lymphoma, and they found that glofit actually did penetrate the CNS. So that paper was really exciting. And actually, ever since that paper, we did have about 10 patients that we treated with glofitamab in particular for secondary CNS lymphoma. And we wrote those patients up for this particular conference. And what we found was that there were actually pretty good responses. Response rates were about 80% in the CNS in particular. There were low rates of toxicity. You sort of worry about cytokine release syndrome and neurotoxicity in particular, those rates were pretty low. The follow-up, unfortunately, has been pretty short, and this is a pretty new therapy for these patients. So I’m really excited to see what comes of this in the future. I think this needs to be done prospectively, however. You know, our study was retrospective, but it’s still really exciting because the median overall survival of secondary CNS lymphoma, we know, is about five months. It’s actually, I would argue, one of the most aggressive B-cell lymphomas. So it’s really exciting to have any therapies that really can prolong patients’ lives when they have this really aggressive disease.
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