SOHO 2023 | New algorithm for second-line DLBCL: the role of CAR-T therapy
Jason Westin, MD, FACP, The University of Texas MD Anderson Cancer Center, Houston, TX, talks on a new algorithm for the second-line treatment of patients with diffuse large B-cell lymphoma (DLBCL), highlighting the role of CAR-T therapy based on findings from recent clinical trials. Dr Westin comments on the superiority of axicabtagene ciloleucel (axi-cel) over the previous standard of care (SOC) of chemotherapy followed by a stem cell transplant (SCT), adding that the latter approach is preferred if patients experience relapse more than one year after initial treatment and are transplant-eligible. This interview took place at the Eleventh Annual Meeting of the Society of Hematologic Oncology (SOHO 2023) held in Houston, TX.
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Transcript (edited for clarity)
It’s exciting when we have new breakthroughs that are practice changing- those don’t happen every day. And thankfully now in large-cell lymphoma, we’ve had that kind of paradigm shift in the second-line treatment for our patients. Over the past 30 years, the historical dogma has been that patients who have relapsed disease should get platinum chemo, and if they respond, go on to receive high dose chemo and an autologous stem cell transplant...
It’s exciting when we have new breakthroughs that are practice changing- those don’t happen every day. And thankfully now in large-cell lymphoma, we’ve had that kind of paradigm shift in the second-line treatment for our patients. Over the past 30 years, the historical dogma has been that patients who have relapsed disease should get platinum chemo, and if they respond, go on to receive high dose chemo and an autologous stem cell transplant. Three randomized Phase III trials were conducted, and over the past few years, we’ve seen two of them read out showing that CAR-T cell therapy, specifically axi-cel and liso-cel, were superior to that previous paradigm of chemo and transplant. A few months ago, we showed that axi-cel is superior with a statistically significant overall survival advantage over chemo and transplant. That’s the first time in nearly 30 years that we’ve seen an overall survival advantage. Now, the standard of care in countries that have access to CAR-T cells is no longer giving chemo in the second-line and transplant. Now it’s giving CAR-T cells. We’ve changed the algorithm from what used to be considered: is the patient eligible for transplant or ineligible for transplant, now to be asking the question: how long ago was first line therapy? The clinical trials I just mentioned were all in patients who had relapsed within one year of their initial treatment. We know that patients who relapse later generally have a better chance to respond to chemo than those who are refractory or early relapse, so the algorithm now is looking at patients who have an early relapse. If you relapse within one year, the preferred approach is CAR-T cell therapy. And, as I mentioned, axi-cel has recently shown a superior overall survival advantage in that space. If you’re beyond one year, then the question is: are you eligible for chemo and transplant? And we think that with this approach, this updated new algorithm, which Dr Laurie Sehn and I published in Blood in 2022, we think that this will allow more people to receive curative intent therapy.
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