ASCO/EHA/ICML 2023 – Paolo Strati

Paolo Strati overviews how patient outcomes can be optimized with current therapies in relapsed or refractory diffuse large B-cell lymphoma in later lines and outlines which innovative approaches might become available in the long run for the treatment of R/R DLBCL. Finally, he explains what can be achieved today in patients with follicular lymphoma and high tumor burden and depicts his personal highlights from this year’s EHA congress.

Here is the full ASCO/EHA/ICML 2023 report.

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DLBCL: treatment of elderly patients and relapsed disease

Overall survival has improved considerably in the setting of diffuse large B-cell lymphoma (DLBCL). However, patients above the age of 80 years are an exception in terms of survival prolongation and therefore face an unmet clinical need [1]. At the same time, this is a group that constitutes an increasing proportion of DLBCL patients.

Waldenström macroglobulinemia: findings from ASPEN and BRUIN

In the management of patients with Waldenström macroglobulinemia (WM), BTK inhibitors have changed the therapeutic landscape and are considered preferred treatment options for the first and later lines. Compared to the first-in-class agent ibrutinib, the potent and irreversible BTK inhibitor zanubrutinib offers improved BTK selectivity that minimizes off-target effects and toxicities.

Outcome improvements in relapsed and untreated marginal zone lymphoma

Systemic treatment for patients with advanced marginal zone lymphoma (MZL) is often based on regimens used in follicular lymphoma, although new agents and combinations are called for. As MZL ­depends on B-cell receptor signaling, treatment with BTK inhibitors is being investigated in clinical trials.

Follicular lymphoma: study results with bispecific antibodies and BTK inhibitors

Follicular lymphoma (FL) is the most common indolent non-Hodgkin lymphoma (NHL) subtype [1]. In general, it remains incurable with standard therapies, and most patients experience multiple relapses over time. Therefore, there remains a great need for innovative new regimens such as the first-in-class CD20xCD3 T-cell–engaging bispecific antibody mosunetuzumab that is being tested in a pivotal phase II trial in patients with relapsed/refractory grade 1-3a FL after ≥ 2 lines of therapy (including an anti-CD20 antibody and an alkylating agent).

Current insights into BTK inhibition and other targeted approaches in CLL

In the setting of early-stage, asymptomatic chronic lymphocytic leukemia (CLL), the concept of watch & wait in the era of targeted agents was challenged by the placebo-controlled, double-blind, phase III CLL12 study. This trial assessed the use of ibrutinib 420 mg OD (n = 182) vs. placebo (n = 181) until symptomatic disease progression in treatment-naïve patients with asymptomatic CLL Binet stage A who had an increased risk due to factors such as del(17p), IGHV mutation status, or age.