The FDA has granted accelerated approval to Roche's Polivy (polatuzumab vedotin-piiq) in combination with bendamustine and Rituxan (rituximab) (BR) for adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) who have received at least two prior therapies. This approval marks a significant advancement in the treatment landscape for this aggressive form of lymphoma, offering a new option for patients who are ineligible for a hematopoietic stem cell transplant.
The accelerated approval was based on data from the Phase 1b/2 GO29365 study, which evaluated the efficacy and safety of Polivy plus BR in patients with R/R DLBCL. The study demonstrated a complete response rate of 40% (16 out of 40 patients) in the Polivy plus BR arm, compared to 18% in the BR alone arm. Furthermore, 45% of patients treated with Polivy plus BR achieved an objective response at the end of treatment, versus 18% in the BR alone arm. Of those who achieved a complete or partial response with Polivy plus BR, 64% had a duration of response lasting at least six months, compared to 30% with BR alone.
Clinical Significance and Pricing
While overall survival data is still being evaluated, the observed response rates and duration of response suggest a clinically meaningful benefit for patients treated with Polivy plus BR. Roche has priced a four-month course of Polivy at approximately $90,000. This positions it as a potentially cost-effective alternative to CAR-T therapies like Gilead’s Yescarta (axicabtagene ciloleucel) and Novartis’ Kymriah (tisagenlecleucel), which have list prices of $373,000 and $475,000, respectively. However, the cost may still be a barrier to access until further clinical data confirms its long-term efficacy.
Mechanism of Action and Safety Profile
Polivy is a first-in-class anti-CD79b antibody-drug conjugate (ADC). The CD79b protein is specifically expressed in the majority of B-cells, making it a promising target for the development of new therapies for non-Hodgkin lymphoma (NHL). Polivy binds to CD79b and destroys these B-cells through the delivery of an anti-cancer agent, which is thought to minimize the effects on normal cells. Unlike CAR-T therapies, Polivy does not produce the extreme side effects such as neurotoxicity and cytokine release syndrome (CRS).
Common adverse reactions occurring in at least 20% of patients, and at least 5% more frequently in patients treated with Polivy plus BR compared to BR alone, included low white blood cell count, low platelet levels, low red blood cell count, numbness, tingling or pain in the hands and feet, diarrhea, fever, decreased appetite, and pneumonia.
Ongoing Development
Polivy is being developed by Roche using Seattle Genetics ADC technology and is currently being investigated for the treatment of several types of NHL. This approval represents an important step forward in providing more treatment options for patients with relapsed or refractory DLBCL.
