Combining New Therapies and MRD Approaches Across Lymphomas

Exciting developments in follicular lymphoma treatment are on the horizon, with ongoing trials exploring the combination of bispecific antibodies with chemotherapy or chemoimmunotherapy in initial treatments and experimenting with dose-limited or time-limited therapies.

Future research may increasingly focus on minimal residual disease (MRD)-directed approaches, potentially allowing for earlier or reduced treatment based on MRD testing outcomes. As these advancements continue, more refined and effective treatment strategies are expected, including a broader adoption of newer agents like bispecific antibodies and evolving CAR-T cell therapies, tailored to patient specific needs and improving long-term outcomes.

Julie Vose, MD, Chief of the Division of Oncology and Hematology at the University of Nebraska Medical Center/Nebraska Medicine, discusses the exciting developments across lymphomas.

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0:10 | I think a lot of these trials are now taking this to the next step, combining some of the bispecific antibodies with chemotherapy or chemoimmunotherapy for upfront settings. They’re also trying to use more dose-limited or time-limited therapy, as well as using this step-up dosing that I described. In addition, I think trials in the future may be more MRD-directed; if patients have negative MRD testing for a couple of different timeframes, then maybe the treatment can be stopped or can be stopped earlier than it otherwise would have been. So, I think there are a lot of different studies we’re going to be seeing with combinations, first-line therapy, and MRD-directed therapy.

1:08 | For diffuse large B cell lymphoma, it is a standard now and is reimbursed by Medicare. So that's definitely a standard that is available as of today. In addition, for mantle cell lymphoma, that's something that can be ordered, and it is a standard of care. follicular lymphoma is not actually approved yet, but a lot of the studies are using it in a research fashion and have found it to be a very strong correlation. I think in the near future, we're going to be seeing a lot more use of MRD as it gets more FDA approved. Also, probably newer techniques that are more sensitive will become available on the MRD testing, and that's going to make it even more potent and useful. The purpose of doing a lot of those testing is to try to decrease the amount of treatment that we give for patients and not over treat patients. So I think in the long term, it's going to be very useful.

2:08 | I think a lot of these bispecific antibodies are becoming more and more available in the community. And I think we'll be seeing a lot more use of those potentially for older people or people that we don't think are chimeric antigen receptor [CAR] T-cell candidates. There's definitely much longer-term information available for CAR T-cell. So if you have a young patient or someone who is physically fit or insurance-wise, able to get CAR T, that's still probably the preferred methodology, at least for diffuse large B cell. In follicular, I think it's still a little bit up in the air. But I think we're going to be seeing a lot more use of some of these newer agents down the road.