General Updates | Bispecific antibodies in DLBCL: promising combinations & moving these agents into earlier lines

So we’ve been able to use bispecifics in high-grade diffuse large B-cell lymphoma now for a number of years, and increasingly we’re being able to use it for other lymphomas as well. This has primarily in the first instance been as single agents, but obviously because of their effectiveness, there have been a lot of trials that have happened and reported or that are ongoing investigating the use of bispecifics higher up in the treatment pathway. So rather than third line plus in the second line or front line setting. Currently, the most activity is in combination with our standard chemotherapy regimens so rather than using them on their own after patients’ disease has come back or is refractory to chemo, giving it alongside chemotherapy and we’ve seen very good data for example from, from the STARGLO study, which was looking at the use of glofitamab with GemOx in those patients who are having treatment second line for diffuse large B-cell lymphoma who are ineligible for a stem cell transplant. And it showed very encouraging outcomes – the primary endpoint was overall survival and it showed a statistically better overall survival compared to the comparator group for R-GemOx. So certainly that’s exciting that we’ve got that option of being able to use this therapy in the second line setting for this cohort of patients. 

I think in terms of interesting combinations going forwards that isn’t in current practice at the moment it’ll be interesting to see what the data is like with bispecifics in the frontline setting, remembering not just kind of the efficacy side of things, but the potential toxicities and the management of the toxicities and how it would be feasible to manage those things if this does become routine practice depending on the results of those trials, so I look forward to seeing data from those trials going forward. And then perhaps also that will be quite interesting is looking at combinations that are perhaps for those patients who are unsuitable for chemotherapy or if we can move away from chemo-free approaches. So, for example, there has been interesting data from the SUNMO study looking at the use of glofitamab plus polatuzumab, which looks like it has very encouraging and good data when compared to a comparator of R-GemOx for this trial the primary endpoint was progression-free survival and again statistically improved progression-free survival for the bispecific containing arm. And then going forwards I think it’ll be interesting to see combinations of perhaps having more than one bispecific given in conjunction with another so that they can work synergistically to try and improve both efficacy but maintain a manageable safety profile of the bispecific. So I think it’s a rapidly evolving field and there will be a lot of data coming up in the next few years on this subject.

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