Bispecific antibodies and CAR T-cell therapies are reshaping the treatment landscape for patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma who have progressed after multiple lines of therapy. These innovative approaches offer improved outcomes compared to conventional chemoimmunotherapy, addressing a critical unmet need in patients with limited treatment options.
Advancements in DLBCL Treatment
For patients with DLBCL who have relapsed or are refractory to at least two prior lines of treatment, the FDA has approved glofitamab-gxbm (Columvi) and epcoritamab-bysp (Epkinly). According to Dr. Amitkumar Mehta, both therapies have demonstrated promising efficacy in this challenging patient population. These bispecific antibodies represent a significant advancement over historical standards, as reflected in retrospective studies like SCHOLAR-1, which serve as benchmarks for evaluating new therapies in this setting.
Shifting Paradigms in Follicular Lymphoma
The treatment paradigm for follicular lymphoma in the third-line setting has also evolved significantly. PI3K inhibitors, once considered a viable option, have been withdrawn due to associated adverse effects, particularly infections. Consequently, CAR T-cell therapies and mosunetuzumab-axgb (Lunsumio) have become critical treatment alternatives, generating high overall response rates and progression-free survival benefits. Epcoritamab has also received FDA approval for relapsed/refractory follicular lymphoma.
CAR T-cell Therapy vs. Bispecific Antibodies
While CAR T-cell therapies have not been directly compared with bispecific antibodies in head-to-head clinical trials, both modalities have significantly improved patient outcomes compared with conventional chemoimmunotherapy. A notable difference lies in the administration setting: CAR T-cell therapy typically requires inpatient admission due to its complexity and cost, whereas bispecific antibodies can often be administered in an outpatient setting. Despite these distinctions, both approaches have led to significant improvements in patient outcomes compared to historical benchmarks in later-line settings.
