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BSH 2023 | Novel treatment approaches for early-stage DLBCL

Wendy Osborne, MBBS (Hons), MRCP, FRCPath, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK, discusses treatment approaches for patients with early-stage diffuse large B-cell lymphoma (DLBCL). In the context of R-CHOP plus radiotherapy, Dr Osborne highlights the importance of developing individualized PET-guided approaches and comparing the risks and benefits of radiotherapy versus an additional cycle of R-CHOP chemotherapy. Dr Osborne also explains how the recent approval of polatuzumab vedotin may play a role, although this agent may not be used in those with early-stage disease as these patients were excluded from the POLARIX study (NCT03274492). This interview took place at the 63rd Annual Scientific Meeting of the British Society for Haematology (BSH) 2023, held in Birmingham, UK.

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Transcript (edited for clarity)

We had a discussion about the optimal management of early-stage DLBCL, because we’ve known for a while that for some patients, we can use combined modality therapy, so using R-CHOP maybe just three cycles with radiotherapy. More recently, we’ve learned that we can use a PET adapted approach, so trying to avoid the radiotherapy. So giving three cycles of R-CHOP and if the PET scan is then negative, giving a fourth cycle of R-CHOP and no radiotherapy...

We had a discussion about the optimal management of early-stage DLBCL, because we’ve known for a while that for some patients, we can use combined modality therapy, so using R-CHOP maybe just three cycles with radiotherapy. More recently, we’ve learned that we can use a PET adapted approach, so trying to avoid the radiotherapy. So giving three cycles of R-CHOP and if the PET scan is then negative, giving a fourth cycle of R-CHOP and no radiotherapy. We discussed in this session that actually we need to individualize the patient discussion as to which is going to be more toxic for the patient, the radiotherapy or an additional dose or cycle of R-CHOP chemotherapy. So that was an important point really that we don’t always want to avoid the radiotherapy. We have newer techniques and sometimes that can be the lesser of two evils for the patients. We also discussed which patients, even though they are early stage, we would consider high-risk. So certainly, my interpretation of the data would be extranodal disease and we often would treat these patients with a full course of six cycles of R-CHOP. You asked about polatuzumab and polatuzumab does now have license and in the UK is reimbursed for IPI 2-5, for patients with advanced disease. So, I don’t use it for my patients with early-stage disease because they were excluded from the POLARIX study. There was a few that did sneak into the study from looking at the data, but for my patients who have early-stage disease, I either treat them with a combined modality approach, a PET guided, limited chemotherapy approach, or for some higher-risk patients, I will treat them with six cycles of chemotherapy and sometimes radiotherapy as well.

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Disclosures

Roche, Takeda, Pfizer, Servier, Kite Gilead, MSD, Novartis, Beigene, Astra Zeneca, Syneos, Autolus, Kyowa Kirin, Abbvie, Incyte, BMS/Celgene, Janssen