Dr Westin on the Updated Treatment Paradigm in Second-Line LBCL

Jason Westin, MD, FACP, director, Lymphoma Clinical Research, section chief, Aggressive Lymphoma, leader, Diffuse Large B-cell Lymphoma Research Team, associate professor, Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses how the approval of CAR T-cell therapies in the second-line setting has radically shifted preferred treatment approaches in relapsed/refractory large B-cell lymphoma (DLBCL).

For approximately 3 decades, it remained the standard-of-care (SOC) to treat strategy for fit patients with LBCL in the second-line involved platinum-based chemotherapy followed by autologous stem cell transplant (ASCT) in responders, Westin begins. However, many patients were ineligible to receive this treatment, or did not benefit from this approach, necessitating the development of alternative strategies, he notes.

Beginning in the third-line setting, the emergence and implementation of CD19-targeted CAR T-cell therapy ushered in a revolutionary paradigm shift for patients with relapsed LBCL, Westin states. Recently, 3 randomized phase 3 studies of second-line CAR T-cell therapy were completed, 2 of which demonstrated the superiority of lisocabtagene maraleucel (liso-cel; Breyanzi) and axicabtagene ciloleucel (axi-cel; Yescarta) compared with the previous SOC, Westin reports.

As a result, a new treatment algorithm has emerged, shifting the decision-making process in this patient population, Westin says. Instead of assessing whether a patient is eligibile for transplant, the updated algorithm focuses on the length of time that has elapsed since the patient completed first-line therapy, he explains. Current research has shown that patients who relapse within 1 year of initial treatment experience improved outcomes with CAR T-cell therapy vs chemotherapy and ASCT, Westin details.

Overall, CAR T-cell therapy is now the preferred choice for patients with relapsed/refractory disease over the prior standard of chemotherapy and ASCT, Westin states. This paradigm shift represents a significant advancement in the management of patients with relapsed LBCL, Westin concludes.