VIDEO: Challenges in managing patients with DLBCL

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You know, a rare subset of DLBCL, that's still a profound unmet need is double hit lymphoma. I guess it's probably well known, but because it's well less than 10% of all patients, our ability to make progress in that subset has been really quite poor. No randomized trials, certainly. And very few prospective trials whatsoever. But you know, if most patients have a 60% cure rate, double hit lymphoma has, you know probably less than a 20% cure rate. So it's a profound unmet need and it's especially hard to do clinical trials for these patients because they present with such aggressive disease sometimes, there's, you know, sometimes not even enough time to do the screening procedures, to enroll them, to consent them and still start therapy in a timely way. So we need to, you know, try to focus on some, multi-center trials that try to get as best prospective data we can for the most promising therapies.

To some degree, this is being looked at. For one example with the Zuma-12 trial trying to get CAR Ts sort of in frontline therapy, it's not, on day one but in some iteration with early chemotherapy. And probably we need to do some trials like that with bispecific antibodies as well. Or other perhaps dose intensification of the standard therapies. We do not know the right therapy for double-hit lymphoma. We kind of know the wrong therapy, that just standard R-CHOP is probably not enough for almost all of these highly aggressive lymphomas. So it's a small subset. We need to really focus on identifying those patients as quickly as possible. There are practical things here as well of getting FISH results back quickly. But certainly prioritizing those patients who seem to have aggressive disease and getting them onto some prospective clinical trials of the most promising therapies as quickly as we can.