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ICML 2025 | Prolonged methotrexate, temozolomide & rituximab in secondary CNS lymphoma
In this video, Nikita Dave, MD, University of Pennsylvania, Philadelphia, PA, shares insights into the efficacy of a chemotherapy regimen combining methotrexate, temozolomide, and rituximab in treating secondary central nervous system (CNS) lymphoma. Dr Dave notes that this regimen resulted in a median overall survival of approximately seven years, significantly longer than the typical five months for this patient population. This interview took place during the 18th International Conference on Malignant Lymphoma (18-ICML) in Lugano, Switzerland.
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Transcript
Yeah, so this is a little bit different from CAR-T and bispecifics in that this is a chemotherapy option, right? Bispecifics and CAR-T are totally chemo-free, but you know, up until more recently, chemotherapy and radiation were really all we had for a secondary CNS lymphoma. And there’s a lot of controversy as to what exactly is the best chemotherapy option for these patients. There’s really no standard of care because, as I mentioned, a lot of these trials, patients tend to be excluded...
Yeah, so this is a little bit different from CAR-T and bispecifics in that this is a chemotherapy option, right? Bispecifics and CAR-T are totally chemo-free, but you know, up until more recently, chemotherapy and radiation were really all we had for a secondary CNS lymphoma. And there’s a lot of controversy as to what exactly is the best chemotherapy option for these patients. There’s really no standard of care because, as I mentioned, a lot of these trials, patients tend to be excluded. So every institution, every country does something a little bit differently. And at Penn, we do something sort of unique in that we use this particular chemotherapy option called MTR or methotrexate, temozolomide, and rituximab. And this is based off the Alliance 51101 trial, which was published in the summer of last year. So we use these three chemotherapy agents. We give it initially every two weeks and then space it out to monthly for induction. And then for maintenance, as a consolidation, we do a monthly maintenance to complete a year of therapy. It’s a pretty unique regimen. We actually just published a paper in Blood Neoplasia just last week with this particular regimen in primary CNS lymphoma. So we wanted to look in particular at our patients with secondary CNS lymphoma since we know the outcomes are so much worse. And as I mentioned, the median overall survival generally of secondary CNS lymphoma is about five months. But with this particular regimen that we use, the median overall survival was about seven years. So it was pretty effective. You know, it’s a small cohort of patients, but we know that the regimen is not very toxic. Oftentimes, these patients are pretty beat up from a lot of the systemic therapies that they’ve already gotten for their systemic lymphoma. So it’s very hard to give them even more aggressive chemotherapy for their CNS lymphoma. So I think in general, managing and balancing toxicity and efficacy is really important. So I think this regimen is pretty efficacious and, you know, no patients really needed to discontinue therapy for toxicity. No patients died from therapy. That’s really important to mention. So I’m really excited that we got to look at these patients and that their outcomes were in a span of years as opposed to a span of months.
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