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Posted by on Jun 5, 2019 in Non-Hodgkin lymphoma | 0 comments

In a nutshell

This study evaluated the effectiveness and safety of polatuzumab vedotin (Pola) combined with chemoimmunotherapy for patients with diffuse large B-cell lymphoma (DLBCL). This study concluded that combining Pola with these regimens was promising, with manageable side effects.

Some background

DLBCL is one of the most common types of non-Hodgkin’s lymphoma (NHL). R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) or G-CHOP (obinutuzumab instead of rituximab, CHOP) chemoimmunotherapy remains the standard treatment for patients with newly diagnosed DLBCL. This treatment is effective in 60 – 70% of patients. However, 30 – 40% of patients experience relapse or develop refractory disease. New treatment strategies are needed.

One approach is to add new anti-cancer drugs to the R-CHOP regimen. Previous studies have evaluated combining R-CHOP with targeted therapies. One such combination involves Pola. Pola is a new monoclonal antibody. This type of treatment binds to cancer cells, leading to cancer cell death. Whether substituting vincristine (Oncovin) in R-CHOP/G-CHOP with polatuzumab vedotin is safe and effective for patients with DLBCL is unclear.

Methods & findings

This study had 85 patients with DLBCL. 75 patients (91%) did not have treatment before. Of these, 66 patients (88%) received polatuzumab vedotin. Of these, 45 patients also received R-CHP (R-CHOP without vincristine). The remaining 21 patients also received G-CHP (G-CHOP without vincristine). Patients were followed-up for an average of 21.5 months.

Overall, 89% of all patients responded to treatment. 78% of patients had a complete disappearance of all signs of cancer (complete response). 11% of patients had tumor shrinkage (partial response).

Overall, 94% of patients were still alive 1 year later, and 91% did not have tumor growth or spread. At 2 83% of all patients were still alive 2 years later without tumor growth or spread.

Overall, all patients experienced side effects. Most of these were mild. The most common included nausea (45%), tiredness (47%), diarrhea (48%), and numbness or tingling in the hands or feet (38%).

65% of patients reported severe side effects. The most common ones were severely low white blood cell count with fever (18%) and without fever (30%). Infections (15%) and low platelet count (cells involved in blood clotting; 9%) were also reported. 11% of patients stopped treatment due to side effects. 8% of patients had dose reductions due to side effects.

The bottom line

This study concluded that combining polatuzumab vedotin with either R-GHP or G-CHP chemoimmunotherapy was promising, with manageable side effects.

The fine print

This was a small study with a short follow-up period. More studies with larger patient populations are needed to confirm these results.

Published By :

The Lancet. Oncology

Date :

May 14, 2019

Original Title :

Polatuzumab vedotin in combination with immunochemotherapy in patients with previously untreated diffuse large B-cell lymphoma: an open-label, non-randomised, phase 1b-2 study.

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