Tailoring Therapy for Patients With DLBCL

Nathan H. Fowler, MD:In the coming years, we are going to continue to see the development and FDA approval of a lot of novel targeted drugs for patients with relapsed large-cell lymphoma. And I think specifically, a lot of these drugs are being developed for patients who are failing a transplant, or are ineligible for a transplant, or cannot get into a remission with salvage chemotherapy. I mentioned tafasitamab. I talked a little about CAR [chimeric antigen receptor] T cells, polatuzumab. There are several other drugs also being developed in this space, which are biological, and some of them are targeted drugs.

As we move forward, as these drugs all become available to the clinician, the big thing is going to be deciding which of these drugs to use in which patient populations. This decision should be based on the drug’s adverse-effect profile, as well as the activity of the drug. In patients, for example, who potentially have compromised organ function, we might not want to use drugs like CAR T cells that could have a really tough effect on their performance status, or drugs that maybe affect heart function or kidney function.

In patients who are of great performance status and are great candidates, I would probably pick CAR T-cell therapy. In patients who are older and have compromised organ function, I might be thinking about a more biological regimen, like tafasitamab plus lenalidomide or, potentially, an emerging novel biological regimen. It’s important to look at the entire profile of the drug, or of the combination, when you’re making these decisions. Again, not only adverse effects but also what the goals of therapy are and what the activity of the combination or the single drug is that you’re planning on using.

Transcript edited for clarity.