EBMT 2024 | The role of bispecific antibodies in the treatment landscape for R/R DLBCL
Wendy Osborne, MBBS (Hons), MRCP, FRCPath, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK, provides insight into the role of bispecific antibodies in treating relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL). She discusses the licensed use of epcoritamab and glofitamab in the third-line setting and beyond. Dr Osborne highlights her preference for bispecific antibodies post-relapse following CAR-T therapy and stresses the need for more research to determine the optimal sequencing of bispecific antibodies with other treatments. Additionally, she anticipates forthcoming data on bispecific antibody use in the second-line setting. This interview took place at the 50th Annual Meeting of the EBMT in Glasgow, Scotland.
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Transcript (edited for clarity)
So I think that there’s a lot of excitement about bispecific antibodies, which are now licensed and in the UK funded third-line and beyond for relapsed/refractory diffuse large B-cell lymphoma. So bispecific antibodies are allowing the patient’s own T-cells to cause tumor cell death, in a rapid fashion because they are off-the-shelf bispecific antibodies. So the CD3 targeting the patient’s own T-cell and the CD20 the lymphoma cell, allowing engagement, T-cell activation and activation of the immune system...
So I think that there’s a lot of excitement about bispecific antibodies, which are now licensed and in the UK funded third-line and beyond for relapsed/refractory diffuse large B-cell lymphoma. So bispecific antibodies are allowing the patient’s own T-cells to cause tumor cell death, in a rapid fashion because they are off-the-shelf bispecific antibodies. So the CD3 targeting the patient’s own T-cell and the CD20 the lymphoma cell, allowing engagement, T-cell activation and activation of the immune system. And I think that the data for both epcoritamab and glofitamab, which are the current two licensed bispecifics are really impressive. For many of the patients they received them in the study in a fourth line and beyond setting, so a very high-risk group of patients, a third had had prior CAR-T. And yet despite this high risk in both studies, a complete response rate was 39% and about two thirds of patients remained in a CR a year and a half later.
So I’m certainly using bispecific antibodies for my patients in a third-line setting. So that’s for patients who have relapsed post-second-line CAR-T, or for some patients fourth-line when they’ve relapsed post-third-line CAR-T. And there are some patients in whom I’m using bispecific antibodies instead of third-line CAR-T, if the kinetics of the disease or the patient fitness are such that I’m concerned about whether they will get to infusion of CAR-T. Because we clearly have longer follow up data for CAR-T, and so that’s still my standard third-line approach, but there’s been some patient selection decisions when I’ve used bispecifics instead.
So I think that really bispecific antibodies are a really exciting new option for patients with relapsed diffuse large B-cell lymphoma. We’re going to see data soon this year looking at bispecifics in a second-line space, which I think we’re all really interested in seeing that efficacy data and also then understanding optimal sequencing of these newer therapies, because we need to understand the impact of one treatment on the subsequent efficacy of the next treatment. So huge changes for large cell lymphoma pathways.
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