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SOHO 2026 | Key considerations for optimizing treatment sequencing in DLBCL
Gilles Salles, MD, PhD, Memorial Sloan Kettering Cancer Center, New York, NY, shares his insights on how to optimally sequence treatment for diffuse large B-cell lymphoma (R/R DLBCL), emphasizing that it is curable for most patients when the right regimen is used. Dr Salles highlights the importance of swiftly moving to second-line approaches, such as CAR T-cell therapy upon failure of first-line regimens, and notes that bispecific antibodies offer efficient treatment options, particularly in combination with gemcitabine and oxaliplatin (GemOx). This interview took place at the 14th Annual Meeting of the Society of Hematologic Oncology (SOHO 2026) in Houston, TX.
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Transcript
When we are talking about managing DLBCL, we have to remember one thing. This is a curable disease in the majority of patients. And we have to apply the right regimen for the right patient. And if this patient fails the first-line regimen, whether it’s R-CHOP or R-CHP, or eventually those are just at the DA-R-EPOCH, we have to move swiftly to other approaches. At this point, the best evidence of a second-line approach is CAR T-cells...
When we are talking about managing DLBCL, we have to remember one thing. This is a curable disease in the majority of patients. And we have to apply the right regimen for the right patient. And if this patient fails the first-line regimen, whether it’s R-CHOP or R-CHP, or eventually those are just at the DA-R-EPOCH, we have to move swiftly to other approaches. At this point, the best evidence of a second-line approach is CAR T-cells. And whether you use axicabtagene or lisocel, you have two products that are available, at least widely in the United States, and we have shown to be better than autologous stem cell transplant. Furthermore, liso-cel is something that you can use in patients up to 80, 85. I just saw yesterday morning one of my patients, he was 81 and he just went out of treatment. So I think we should offer that because they have demonstrated a very prolonged survival in patients who achieve the CR. They probably cure about half of the patients who fail, and particularly those who failed early. Bispecifics are mostly developed in the third-line setting, but also in the first-line setting. However, while not yet approved in the second-line setting, we have learned that gloftimab GemOx is very efficient and more efficient than R GemOx. Epcor GemOx is also efficient. And I think when patients cannot access CAR-T, combining a bispecific antibody with either GemOx or maybe other drugs in the future, such as lenalidomide or polatuzumab vedotin, or loncastuximab, may offer the patient a chance of achieving a new CR. And we have learned also recently that CR with bispecifics could be prolonged and patients can be cured with bispecifics either alone or in combination. So I think what we should avoid is really when patients’ first-line therapy, managing them with ADCs alone, with second-line agents and things like that. Either they go for CAR-T or they go for a bispecific combination, that’s the best chance of cure for them.
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