VIDEO: Where to focus future DLBCL research

Editor’s note: This is a previously posted video, and the below is an automatically generated transcript to be used for informational purposes. Please notify editor@healio.com if there are concerns regarding accuracy of the transcription.

We're real lucky in lymphoma and in diffuse large B-cell lymphoma specifically because it's not true for all lymphoma because T-cell lymphomas haven't had as much benefit from clinical research as B-cell lymphomas have. But we're so lucky to be in this space. We have a problem of abundance in terms of the number of great therapies that have been developed over the past decade and that are being developed. And again, compared to the advances in other tumor types, well you can just objectively even say that today more FDA-approved therapies for lymphomas than for any other cancer type. Lymphoma, the fifth most common cancer, but more FDA-approved therapies than any other type. Meaning that we have developed more effective therapies. We only get approvals when we've shown efficacy compared to the prior generation of therapies. So to choose one direction for where researcher goes is tricky.

But just on the last thing we were talking about bispecific antibodies and their advent, there's a critically important sort of practical step here beyond just the scientific advances and the immunological concepts that allow bispecific antibodies to work well and hopefully I think to work even better in the near future. The practical considerations are how are we going to get these integrated into community oncology setting. Because although the bispecific antibodies much easier to use than for example, CAR T-cells or of course autologous transplant, they're still not as easy to use as rituximab. I mean, they're still not completely benign. And the main primary adverse effect of bispecific antibodies that we worry about is cytokine release syndrome. This happens in a lot of patients treated with bispecific antibodies but it is mostly low grade, Grade 1 or Grade 2, and maybe 3% to 5% of patients with Grade 3 to 4 but mostly Grade 3 cytokine release syndrome.

And overall, that usually requires, for us in the trials we've done so far, a one night stay in the hospital just for observation. Most patients just get observed, go home the next day. Pretty boring. But if there's a 5% chance of Grade 3 CRS, they might have to go to the intensive care unit so we need for them to be in the trials in the hospital. So we're going to have to be finding ways to do this with our community oncology colleagues that is maybe even more practical. Even meaning finding the patient at low enough risk that could maybe only be treated in the outpatient setting, would never need hospitalization or finding ways to mitigate CRS to predict it, to intervene quickly even before patients need fluids or vasopressin or pressors, and to avoid the need for intensive care units overall. So there's some practical progress that needs to be made there. Identifying the subset of patients at very low risk of CRS and treating them in the outpatient setting exclusively. And some of these trials have already started. There are some trials of bispecific antibodies focused only on community oncology settings and actually excluding the academic centers. So I think that's an important next direction for clinical research to go in so that all patients could get the great benefit that we've seen with bispecific antibodies in the academic centers.