Dr. D’Angelo on the Potential Drawbacks of 5-Drug Combinations in B-Cell Lymphoma

Christopher R. D’Angelo, MD, an assistant professor in the Department of Internal Medicine, Division of Hematology/Oncology at the University of Nebraska Medical Center, discusses the potential drawbacks of 5-drug combinations in B-cell lymphoma.

The 5-drug ViPOR combination of venetoclax (Venclexta), ibrutinib (Imbruvica), prednisone, obinutuzumab (Gazyva), and lenalidomide (Revlimid) is being evaluated in a phase 1b/2 trial (NCT03223610) in patients with relapsed/refractory B-cell lymphoma.

Adding more agents to a traditional doublet regimen confers potential drawbacks, including the risk of significant toxicity, says D’Angelo. Moreover, when multiple agents are added to a single regimen, patients are left with less options should they relapse, D’Angelo explains. Additionally, some novel treatment strategies are utilizing oral agents, which are often dosed indefinitely or until a patient progresses or relapses, D’Angelo explains.

Time-limited combinations that are not associated with significant up-front toxicity and can prolong survival are intriguing, D’Angelo says. However, multiple-drug combinations that induce responses but do not prolong life may not be optimal for this patient population, concludes D’Angelo.