Radiotherapy/CAR T Combo May be “Great Option” in Relapsed/Refractory DLBCL

CancerNetwork^® spoke with Timothy Robinson, MD, PhD, about the key takeaways of a presentation he gave at the 2024 American Society for Radiation Oncology (ASTRO) Annual Meeting on how radiation may be incorporated as bridging therapy in combination with CAR T-cell therapy among patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL).

Describing this combinational strategy as a “great option”, Robinson, an assistant professor of therapeutic radiology at Yale Cancer Center, emphasized there was no evidence of synergistic toxicity when administering radiotherapy plus CAR T-cell therapy in this population. Additionally, he stated that this approach may be considered for patients with a single site of disease and suggested that others in the field should educate patients so that they can know about the use of CAR T-cell therapy more broadly.

Transcript:

I would say a couple of things. One, don’t be afraid of radiation and CAR T. As I mentioned, there’s no evidence of synergistic toxicity, and this can be an effective way just to get somebody to the starting block. That’s the first big takeaway message: for patients who need a bridge from point A to point B, this is a great option.

Two, for patients with relatively localized disease, this is something we can think about. This is an area of ongoing, evolving treatment. But if you’ve got a patient with 1 site of disease—that’s the only thing they have, and it’s a high-risk spot—bridging radiation is becoming a standard at tertiary care centers who treat a lot of [these patients].

Lastly, I would say to just keep an eye out. You [should] get patients to know more broadly about CAR T and how it works. CAR T, right now, for lymphoma, is approved in the [second or] third line for patients who have primary refractory disease—meaning that before they even finished chemotherapy, their disease was coming back—or early relapse [when patients] finish chemotherapy and the disease is gone, but within 12 months, it’s back. If it’s early relapsed or refractory disease, those patients are also eligible for CAR T therapy.

If you have a patient and their disease is just not responding to chemotherapy, more chemotherapy is not the answer. Figuring out how to get that patient to CAR T and how radiation can be helpful in that [treatment] is the big takeaway on that front.

Reference

Robinson T. Radiotherapy’s effective incorporation with chimeric antigen receptor (CAR)-T cell therapy for relapsed/refractory diffuse large B-cell lymphoma. Presented at: 2024 American Society for Radiation Oncology Annual Meeting; September 29-October 2, 2024; Washington, DC.