Amitkumar Mehta, MD, on Compelling Data From ASH in the Treatment of Lymphoma

Amitkumar Mehta, MD, associate professor of medicine – hematology & oncology and director of the Lymphoma Working Group at the University of Alabama Birmingham School of Medicine, spoke with CancerNetwork® at the 2021 American Society of Hematology Annual Meeting about a handful of studies focused on the treatment of lymphoma.

Mehta mentioned the POLARIX trial (NCT03274492)¹, which looked at standard regimens plus polatuzumab vedotin (Polivy) in diffuse large B-cell lymphoma (DLBCL). He also detailed takeaways from the TRANSFORM (NCT03575351)² and ZUMA-7 studies (NCT03391466),³ focused on lisocabtagene maraleucel (Breyanzi) vs standard of care for transplant-eligible relapsed/refractory aggressive B-cell non-Hodgkin lymphomas and axicabtagene ciloleucel (Yescarta) vs standard of care for relapsed/refractory DLBCL, respectively.

Transcript:

If you look at frontline data in the POLARIX trial where R-CHOP [rituximab (Rituxan) plus cyclophosphamide, doxorubicin, vincristine, and prednisone] was compared with R-CHP [rituximab plus cyclophosphamide, doxorubicin, and prednisone], [both plus polatuzumab vedotin], that study was positive. I’m hopeful that in a select population of large cell lymphoma, especially high-risk, high IPI [International Prognostic Index] disease, a novel combination is emerging for the first time in many years. We will be looking at a treatment which is better than R-CHOP.

For second-line data in the relapse [setting for] large cell lymphoma, you see the CAR T data where primary refractory patients were [treated] with either standard of care consolidated autologous transplant versus CAR T. Two studies, the TRANSFORM study as well as the ZUMA-7 study were positive in that setting. I’m hopeful that in the future we’ll have CAR T approved in the second-line setting.

Lastly, parsaclisib was looked at in the marginal zone lymphoma and the follicular lymphoma settings. If you look at marginal zone lymphoma, [which is a] very rare lymphoma, the toxicity profile and the trial design were similar in the weekly and daily dosing group. We saw good activity in marginal zone lymphoma which I’m hopeful is also another alternative treatment in [MZL] and in follicular lymphoma. There are many PI3K δ [inhibitors] approved, but parsaclisib was designed specifically to avoid hepatotoxicities and transaminitis which we did not see in all 3 studies.

References

1. Tilly H, Morschhauser F, Sehn LH, et al. The POLARIX study: Polatuzumab vedotin with rituximab, cyclophosphamide, doxorubicin, and prednisone (pola-R-CHP) versus rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) therapy in patients with previously untreated diffuse large B-cell lymphoma. Blood. 2021;138(suppl 2):LBA-1. doi:10.1182/blood-2021-154729
2. Kamdar M, Solomon SR, Arnason JE, et al. Lisocabtagene maraleucel (liso-cel), a CD19-directed chimeric antigen receptor (CAR) T cell therapy, versus standard of care (SOC) with salvage chemotherapy (CT) followed by autologous stem cell transplantation (ASCT) as second-line (2L) treatment in patients (Pts) with relapsed or refractory (R/R) large B-cell lymphoma (LBCL): Results from the randomized phase 3 Transform study. Blood. 2021;138(suppl 1):91. doi:10.1182/blood-2021-147913
3. Locke FL, Miklos DB, Jacobson C, et al. Primary analysis of ZUMA-7: A phase 3 randomized trial of axicabtagene ciloleucel (axi-cel) versus standard-of-care therapy in patients with relapsed/refractory large B-cell lymphoma. Blood.2021;138(suppl 1):2. doi: 10.1182/blood-2021-148039