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Shaw B, Chung E, Wellard C, Yoo E, Bennett R, Birks C, Johnston A, Cheah CY, Hamad N, Simpson J, Barraclough A, Ku M, Viiala N, Ratnasingam S, Armytage T, Cochrane T, Chong G, Lee D, Manos K, Keane C, Wallwork S, Opat S, Hawkes EA. Poor outcomes for trial-ineligible patients receiving polatuzumab for relapsed/refractory diffuse large B-cell lymphoma in routine care: An Australian Lymphoma and Related Diseases Registry project. EJHaem 2024; 5:325-332. [PMID: 38633125 PMCID: PMC11020125 DOI: 10.1002/jha2.870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 04/19/2024]
Abstract
Polatuzumab vedotin (Pola) is an approved therapy in combination with rituximab and bendamustine for relapsed or refractory diffuse large B-cell lymphoma (RR-DLBCL) based on positive results of the landmark phase II randomised G029365 trial. However, trial results for many approved novel therapies in RR-DLBCL have not been replicated in routine care cohorts, as RR-DLBCL patient populations are heterogeneous and trial eligibility is increasingly restrictive. We evaluated outcomes from pola ± bendamustine and rituximab in patients with RR-DLBCL enrolled in a compassionate access program with no alternative treatment options identified via the Australasian Lymphoma and Related Diseases Registry according to their eligibility for the original phase II published study. Of 58 eligible patients, 74% met the criteria deeming them ineligible for the G029365 original study at the time of pola's commencement. Median progression-free survival and overall survival in our cohort were 2.3 and 3.5 months, respectively. In contrast to the landmark trial cohort, more of our patients ceased therapy prior to completion, the majority due to progressive disease and only 8/58 received any subsequent treatment. Dismal outcomes in this Australian real-world population demonstrate trial eligibility is challenging to meet, and newer treatments can be difficult to deliver in routine care. Clinically applicable results from therapeutic studies require trial cohorts to reflect representative clinical populations wherever possible, and more research is required to address the benefit of novel agents in the increasing majority who are ineligible for modern studies.
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Affiliation(s)
- Briony Shaw
- Department of HaematologyMonash HealthClaytonAustralia
- School of Public Health and Preventive Medicine, Monash UniversityMelbourneAustralia
| | - Eliza Chung
- School of Public Health and Preventive Medicine, Monash UniversityMelbourneAustralia
| | - Cameron Wellard
- School of Public Health and Preventive Medicine, Monash UniversityMelbourneAustralia
| | - Edward Yoo
- Department of HaematologySir Charles Gairdner HospitalPerthAustralia
| | - Rory Bennett
- Department of HaematologyPeter MacCallum Cancer CentreMelbourneAustralia
| | | | - Anna Johnston
- Department of Clinical HaematologyRoyal Hobart HospitalHobartAustralia
| | - Chan Y Cheah
- Department of HaematologySir Charles Gairdner HospitalPerthAustralia
- Medical School, University of Western AustraliaNedlandsAustralia
| | - Nada Hamad
- Department of HaematologySt Vincent's HospitalSydneyAustralia
- School of Clinical Medicine, Faculty of Medicine and HealthUNSW SydneyAustralia
- School of MedicineUniversity of Notre Dame AustraliaSydneyAustralia
| | - Jock Simpson
- Department of HaematologyPort Macquarie Base HospitalPort MacquarieAustralia
| | | | - Matthew Ku
- Department of HaematologySt Vincent's HospitalMelbourneAustralia
- Faculty of MedicineUniversity of MelbourneMelbourneAustralia
| | - Nicholas Viiala
- Department of HaematologyLiverpool HospitalSydneyAustralia
- South West Sydney Clinical Campus, School of Clinical Medicine, Faculty of Medicine and HealthUNSW SydneyAustralia
| | - Sumita Ratnasingam
- Department of Clinical HaematologyUniversity Hospital GeelongGeelongAustralia
| | | | - Tara Cochrane
- Department of HaematologyGold Coast University HospitalGold CoastAustralia
- Griffith UniversityGold CoastAustralia
| | - Geoffrey Chong
- Department of Medical OncologyGrampians HealthBallaratAustralia
| | - Denise Lee
- Department of HaematologyEastern HealthMelbourneAustralia
| | - Kate Manos
- Department of HaematologyFlinders Medical CentreAdelaideAustralia
| | - Colm Keane
- Department of HaematologyPrincess Alexandra HospitalBrisbaneAustralia
| | | | - Stephen Opat
- Department of HaematologyMonash HealthClaytonAustralia
- School of Public Health and Preventive Medicine, Monash UniversityMelbourneAustralia
| | - Eliza A. Hawkes
- School of Public Health and Preventive Medicine, Monash UniversityMelbourneAustralia
- Department of Medical Oncology and Clinical HaematologyOlivia Newton‐John Cancer Research Institute at Austin HealthHeidelbergAustralia
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2
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Watanabe T. Gene targeted and immune therapies for nodal and gastrointestinal follicular lymphomas. World J Gastroenterol 2023; 29:6179-6197. [PMID: 38186866 PMCID: PMC10768399 DOI: 10.3748/wjg.v29.i48.6179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/02/2023] [Accepted: 12/18/2023] [Indexed: 12/27/2023] Open
Abstract
Follicular lymphoma (FL) is the most common indolent B-cell lymphoma (BCL) globally. Recently, its incidence has increased in Europe, the United States, and Asia, with the number of gastrointestinal FL cases expected to increase. Genetic abnormalities related to t(14;18) translocation, BCL2 overexpression, NF-κB pathway-related factors, histone acetylases, and histone methyltransferases cause FL and enhance its proliferation. Meanwhile, microRNAs are commonly used in diagnosing FL and predicting patient prognosis. Many clinical trials on novel therapeutics targeting these genetic abnormalities and immunomodulatory mechanisms have been conducted, resulting in a marked improvement in therapeutic outcomes for FL. Although developing these innovative therapeutic agents targeting specific genetic mutations and immune pathways has provided hope for curative options, FL treatment has become more complex, requiring combinatorial therapeutic regimens. However, optimal treatment combinations have not yet been achieved, highlighting the importance of a complete under-standing regarding the pathogenesis of gastrointestinal FL. Accordingly, this article reviews key research on the molecular pathogenesis of nodal FL and novel therapies targeting the causative genetic mutations. Moreover, the results of clinical trials are summarized, with a particular focus on treating nodal and gastrointestinal FLs.
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Affiliation(s)
- Takuya Watanabe
- Department of Internal Medicine and Gastroenterology, Watanabe Internal Medicine Aoyama Clinic, Niigata 9502002, Japan
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3
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Russler-Germain DA, Cliff ERS, Bartlett NL. Cell-of-origin effect of polatuzumab vedotin in diffuse large B-cell lymphoma: no ordinary subgroup analysis. Blood 2023; 142:2216-2219. [PMID: 37797275 DOI: 10.1182/blood.2023022048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/11/2023] [Accepted: 09/29/2023] [Indexed: 10/07/2023] Open
Abstract
ABSTRACT Subgroup analysis from the POLARIX trial of polatuzumab vedotin plus chemotherapy for untreated large B-cell lymphoma suggests greater efficacy among patients with activated B-cell subtype disease. Both preclinical and additional clinical evidence support this interaction between cell-of-origin and polatuzumab efficacy.
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Affiliation(s)
- David A Russler-Germain
- Division of Oncology, Washington University School of Medicine, St. Louis, MO
- Siteman Cancer Center, St. Louis, MO
| | - Edward R Scheffer Cliff
- Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Nancy L Bartlett
- Division of Oncology, Washington University School of Medicine, St. Louis, MO
- Siteman Cancer Center, St. Louis, MO
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4
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Kelkar AH, Cliff ERS, Jacobson CA, Abel GA, Dijk SW, Krijkamp EM, Redd R, Zurko JC, Hamadani M, Hunink MGM, Cutler C. Second-Line Chimeric Antigen Receptor T-Cell Therapy in Diffuse Large B-Cell Lymphoma : A Cost-Effectiveness Analysis. Ann Intern Med 2023; 176:1625-1637. [PMID: 38048587 DOI: 10.7326/m22-2276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND First-line treatment of diffuse large B-cell lymphoma (DLBCL) achieves durable remission in approximately 60% of patients. In relapsed or refractory disease, only about 20% achieve durable remission with salvage chemoimmunotherapy and consolidative autologous stem cell transplantation (ASCT). The ZUMA-7 (axicabtagene ciloleucel [axi-cel]) and TRANSFORM (lisocabtagene maraleucel [liso-cel]) trials demonstrated superior event-free survival (and, in ZUMA-7, overall survival) in primary-refractory or early-relapsed (high-risk) DLBCL with chimeric antigen receptor T-cell therapy (CAR-T) compared with salvage chemoimmunotherapy and consolidative ASCT; however, list prices for CAR-T exceed $400 000 per infusion. OBJECTIVE To determine the cost-effectiveness of second-line CAR-T versus salvage chemoimmunotherapy and consolidative ASCT. DESIGN State-transition microsimulation model. DATA SOURCES ZUMA-7, TRANSFORM, other trials, and observational data. TARGET POPULATION "High-risk" patients with DLBCL. TIME HORIZON Lifetime. PERSPECTIVE Health care sector. INTERVENTION Axi-cel or liso-cel versus ASCT. OUTCOME MEASURES Incremental cost-effectiveness ratio (ICER) and incremental net monetary benefit (iNMB) in 2022 U.S. dollars per quality-adjusted life-year (QALY) for a willingness-to-pay (WTP) threshold of $200 000 per QALY. RESULTS OF BASE-CASE ANALYSIS The increase in median overall survival was 4 months for axi-cel and 1 month for liso-cel. For axi-cel, the ICER was $684 225 per QALY and the iNMB was -$107 642. For liso-cel, the ICER was $1 171 909 per QALY and the iNMB was -$102 477. RESULTS OF SENSITIVITY ANALYSIS To be cost-effective with a WTP of $200 000, the cost of CAR-T would have to be reduced to $321 123 for axi-cel and $313 730 for liso-cel. Implementation in high-risk patients would increase U.S. health care spending by approximately $6.8 billion over a 5-year period. LIMITATION Differences in preinfusion bridging therapies precluded cross-trial comparisons. CONCLUSION Neither second-line axi-cel nor liso-cel was cost-effective at a WTP of $200 000 per QALY. Clinical outcomes improved incrementally, but costs of CAR-T must be lowered substantially to enable cost-effectiveness. PRIMARY FUNDING SOURCE No research-specific funding.
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Affiliation(s)
- Amar H Kelkar
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston; Harvard Medical School, Boston; and Harvard T.H. Chan School of Public Health, Boston, Massachusetts (A.H.K.)
| | - Edward R Scheffer Cliff
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston; Harvard Medical School, Boston; Harvard T.H. Chan School of Public Health, Boston; and Program on Regulation, Therapeutics and Law, Brigham and Women's Hospital, Boston, Massachusetts (E.R.S.C.)
| | - Caron A Jacobson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, and Harvard Medical School, Boston, Massachusetts (C.A.J., G.A.A., C.C.)
| | - Gregory A Abel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, and Harvard Medical School, Boston, Massachusetts (C.A.J., G.A.A., C.C.)
| | - Stijntje W Dijk
- Department of Radiology and Nuclear Medicine and Department of Epidemiology and Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands (S.W.D.)
| | - Eline M Krijkamp
- Department of Epidemiology and Biostatistics, Erasmus University Medical Center, Rotterdam, and Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands (E.M.K.)
| | - Robert Redd
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts (R.R.)
| | - Joanna C Zurko
- Division of Hematology & Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (J.C.Z.)
| | - Mehdi Hamadani
- BMT & Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin (M.H.)
| | - M G Myriam Hunink
- Harvard T.H. Chan School of Public Health, Boston, and Program on Regulation, Therapeutics and Law, Brigham and Women's Hospital, Boston, Massachusetts; and Department of Epidemiology and Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands (M.G.M.H.)
| | - Corey Cutler
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, and Harvard Medical School, Boston, Massachusetts (C.A.J., G.A.A., C.C.)
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Izutsu K, Kumode T, Yuda J, Nagai H, Mishima Y, Suehiro Y, Yamamoto K, Fujisaki T, Ishitsuka K, Ishizawa K, Ikezoe T, Nishikori M, Akahane D, Fujita J, Dinh M, Soong D, Noguchi H, Buchbjerg JK, Favaro E, Fukuhara N. Subcutaneous epcoritamab monotherapy in Japanese adults with relapsed/refractory diffuse large B-cell lymphoma. Cancer Sci 2023; 114:4643-4653. [PMID: 37921363 PMCID: PMC10728012 DOI: 10.1111/cas.15996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/08/2023] [Accepted: 10/03/2023] [Indexed: 11/04/2023] Open
Abstract
Epcoritamab is a subcutaneously administered CD3xCD20 bispecific Ab that showed deep, durable responses with a manageable safety profile in patients with relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL) in the global multicenter pivotal phase II trial EPCORE NHL-1. Here, we present results from the similar EPCORE NHL-3 phase I/II trial evaluating epcoritamab monotherapy in Japanese patients with R/R CD20+ B-cell non-Hodgkin's lymphoma previously treated with two or more lines of therapy. Epcoritamab was dosed subcutaneously in 28-day cycles; once weekly during cycles 1-3, every 2 weeks during cycles 4-9, and every 4 weeks from cycle 10 until disease progression or unacceptable toxicity. Step-up dosing and cytokine release syndrome (CRS) prophylaxis were used during treatment cycle 1. As of January 31, 2022, 36 patients received treatment with 48 mg epcoritamab monotherapy. At a median follow-up of 8.4 months, overall response and complete response rates by independent review committee were 55.6% and 44.4%, respectively. The median duration of response, duration of complete response, and overall survival were not reached at the time of data cut-off. The most common treatment-emergent adverse events of any grade were CRS (83.3%), injection-site reactions (69.4%), infections (44.4%), neutropenia (38.9%), hypokalemia (27.8%), and decreased lymphocyte count (25.0%). Cytokine release syndrome occurrence was predictable; events were primarily low grade (grade 1-2), all resolved, and none led to treatment discontinuation. These encouraging results are consistent with previous findings and support the ongoing clinical evaluation of epcoritamab for the treatment of R/R DLBCL, including in earlier treatment lines.
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Affiliation(s)
- Koji Izutsu
- Department of HematologyNational Cancer Center HospitalTokyoJapan
| | - Takahiro Kumode
- Department of Hematology and RheumatologyKindai UniversityOsakaJapan
| | - Junichiro Yuda
- Departments of Hematology and Experimental Therapeutics, Office for the Promotion of Hematological Treatment DevelopmentNational Cancer Center Hospital EastKashiwaJapan
| | - Hirokazu Nagai
- Department of HematologyNational Hospital Organization Nagoya Medical CenterNagoyaJapan
| | - Yuko Mishima
- Department of Hematology Oncology, Japanese Foundation for Cancer ResearchCancer Institute HospitalTokyoJapan
| | - Youko Suehiro
- Department of Hematology and Cell TherapyNational Hospital Organization Kyushu Cancer CenterFukuokaJapan
| | - Kazuhito Yamamoto
- Department of Hematology and Cell TherapyAichi Cancer CenterNagoyaJapan
| | - Tomoaki Fujisaki
- Department of HematologyJapan Red Cross Society, Matsuyama Red Cross HospitalMatsuyamaJapan
| | - Kenji Ishitsuka
- Department of Hematology and RheumatologyKagoshima UniversityKagoshimaJapan
| | - Kenichi Ishizawa
- Third Department of Internal MedicineYamagata UniversityYamagataJapan
| | - Takayuki Ikezoe
- Department of HematologyFukushima Medical University HospitalFukushimaJapan
| | - Momoko Nishikori
- Department of Hematology and Oncology, Graduate School of MedicineKyoto UniversityKyotoJapan
| | - Daigo Akahane
- Department of HematologyTokyo Medical UniversityTokyoJapan
| | - Jiro Fujita
- Department of Hematology and Oncology, Graduate School of MedicineOsaka UniversityOsakaJapan
| | - Minh Dinh
- Oncology Clinical DevelopmentAbbVieNorth ChicagoIllinoisUSA
| | - David Soong
- Translational Data ScienceGenmabPlainsboroNew JerseyUSA
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6
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Kawasaki N, Tomita M, Yamashita-Kashima Y, Yoshimura Y, Yoshiura S. Efficacy of retreatment with polatuzumab vedotin in combination with rituximab in polatuzumab vedotin-resistant DLBCL models. Leuk Lymphoma 2023; 64:1938-1948. [PMID: 37548343 DOI: 10.1080/10428194.2023.2243531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023]
Abstract
Polatuzumab vedotin (Pola) was approved for first-line and relapsed/refractory (r/r) diffuse large B-cell lymphoma (DLBCL) in many countries. This means that retreatment with Pola for r/r DLBCL could be considered after first-line Pola treatment; however, there is currently no evidence on the effectiveness of Pola-retreatment. To address this, we established two Pola-resistant cells from DLBCL cells (SU-DHL-4 and STR-428) and evaluated the combination efficacy of Pola plus rituximab (Rit), the key component of DLBCL therapy. MDR1 overexpression and decreased Bim expression were suggested to be the resistant mechanisms to Pola in Pola-resistant SU-DHL-4 and Pola-resistant STR-428, respectively. In these cells, Pola significantly increased Rit-induced CDC sensitivity either with increased MAC formation or reduced Mcl-1 expression. Additionally, treatment with Pola + Rit significantly enhanced antitumor activity in Pola-resistant STR-428 xenograft mouse models. Based on these results, Pola + Rit retreatment could have preserved efficacy because of the effect of Pola on sensitizing cells to Rit.
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Affiliation(s)
- Natsumi Kawasaki
- Product Research Department, Chugai Pharmaceutical Co., Ltd., Kanagawa, Japan
| | - Mayu Tomita
- Product Research Department, Chugai Pharmaceutical Co., Ltd., Kanagawa, Japan
| | | | - Yasushi Yoshimura
- Product Research Department, Chugai Pharmaceutical Co., Ltd., Kanagawa, Japan
| | - Shigeki Yoshiura
- Product Research Department, Chugai Pharmaceutical Co., Ltd., Kanagawa, Japan
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7
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Kosugi S, Kanno M, Inoue Y. Successful treatment of relapsed/refractory transformed aggressive B-cell lymphoma with polatuzumab vedotin combined with bendamustine and rituximab followed by non-myeloablative related HLA-haploidentical stem cell transplantation. Ann Hematol 2023; 102:3277-3278. [PMID: 37561153 DOI: 10.1007/s00277-023-05366-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/07/2023] [Indexed: 08/11/2023]
Affiliation(s)
- Shigeki Kosugi
- Department of Hematology, St. Marianna University Yokohama City Seibu Hospital, 1197-1 Yasashi-Chou, Asahi-Ku, Yokohama, Kanagawa, 241-0811, Japan
| | - Masatoshi Kanno
- Department of Hematology, St. Marianna University Yokohama City Seibu Hospital, 1197-1 Yasashi-Chou, Asahi-Ku, Yokohama, Kanagawa, 241-0811, Japan
| | - Yasuyuki Inoue
- Department of Hematology, St. Marianna University Yokohama City Seibu Hospital, 1197-1 Yasashi-Chou, Asahi-Ku, Yokohama, Kanagawa, 241-0811, Japan.
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8
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Bettio D, Page G, Thoreau V. Blue marine therapy: Sea as a trove of natural anticancer drugs. Ann Pharm Fr 2023; 81:935-941. [PMID: 37328028 DOI: 10.1016/j.pharma.2023.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/31/2023] [Accepted: 06/10/2023] [Indexed: 06/18/2023]
Abstract
The great variability of marine habitats and the species that live there allows the development of organisms with unique characteristics. These represent an excellent source of natural compounds and are therefore interesting in the search for new bioactive molecules. In recent years, many marine-based drugs have been commercialized or are currently under investigation, mainly in the treatment of cancer. This mini-review summarizes the marine-based drugs currently marketed and presents a non-exhaustive list of molecules currently in clinical trials, as monotherapy but also in combination with classical anticancer treatments.
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Affiliation(s)
- Delphine Bettio
- University of Poitiers, Medicine and Pharmacy Faculty, bâtiment D1, 6 rue de la Milétrie, TSA 51115, 86073 Poitiers cedex 9, France.
| | - Guylène Page
- University of Poitiers, Medicine and Pharmacy Faculty, bâtiment D1, 6 rue de la Milétrie, TSA 51115, 86073 Poitiers cedex 9, France; University of Poitiers, Neurovascular Unit and Cognitive Disorders (NEUVACOD), Pôle biologie santé, 1, rue Georges-Bonnet, TSA 51106, 86073 Poitiers cedex 9, France
| | - Vincent Thoreau
- University of Poitiers, Medicine and Pharmacy Faculty, bâtiment D1, 6 rue de la Milétrie, TSA 51115, 86073 Poitiers cedex 9, France; University of Poitiers, Neurovascular Unit and Cognitive Disorders (NEUVACOD), Pôle biologie santé, 1, rue Georges-Bonnet, TSA 51106, 86073 Poitiers cedex 9, France
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9
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Nowakowski GS, Yoon DH, Mondello P, Joffe E, Peters A, Fleury I, Greil R, Ku M, Marks R, Kim K, Zinzani PL, Trotman J, Sabatelli L, Waltl EE, Winderlich M, Sporchia A, Kurukulasuriya NC, Cordoba R, Hess G, Salles G. RE-MIND2: comparative effectiveness of tafasitamab plus lenalidomide versus polatuzumab vedotin/bendamustine/rituximab (pola-BR), CAR-T therapies, and lenalidomide/rituximab (R2) based on real-world data in patients with relapsed/refractory diffuse large B-cell lymphoma. Ann Hematol 2023; 102:1773-1787. [PMID: 37171597 PMCID: PMC10261238 DOI: 10.1007/s00277-023-05196-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 03/23/2023] [Indexed: 05/13/2023]
Abstract
RE-MIND2 (NCT04697160) compared patient outcomes from the L-MIND (NCT02399085) trial of tafasitamab+lenalidomide with those of patients treated with other therapies for relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) who are autologous stem cell transplant ineligible. We present outcomes data for three pre-specified treatments not assessed in the primary analysis. Data were retrospectively collected from sites in North America, Europe, and the Asia Pacific region. Patients were aged ≥18 years with histologically confirmed DLBCL and received ≥2 systemic therapies for DLBCL (including ≥1 anti-CD20 therapy). Patients enrolled in the observational and L-MIND cohorts were matched using propensity score-based 1:1 nearest-neighbor matching, balanced for six covariates. Tafasitamab+lenalidomide was compared with polatuzumab vedotin+bendamustine+rituximab (pola-BR), rituximab+lenalidomide (R2), and CD19-chimeric antigen receptor T-cell (CAR-T) therapies. The primary endpoint was overall survival (OS). Secondary endpoints included treatment response and progression-free survival. From 200 sites, 3,454 patients were enrolled in the observational cohort. Strictly matched patient pairs consisted of tafasitamab+lenalidomide versus pola-BR (n = 24 pairs), versus R2 (n = 33 pairs), and versus CAR-T therapies (n = 37 pairs). A significant OS benefit was observed with tafasitamab+lenalidomide versus pola-BR (HR: 0.441; p = 0.034) and R2 (HR: 0.435; p = 0.012). Comparable OS was observed in tafasitamab+lenalidomide and CAR-T cohorts (HR: 0.953, p = 0.892). Tafasitamab+lenalidomide appeared to improve survival outcomes versus pola-BR and R2, and comparable outcomes were observed versus CAR-T. Although based on limited patient numbers, these data may help to contextualize emerging therapies for R/R DLBCL. CLINICAL TRIAL REGISTRATION: NCT04697160 (January 6, 2021).
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Affiliation(s)
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, Songpa-gu, Seoul, South Korea
| | - Patrizia Mondello
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Erel Joffe
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anthea Peters
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Isabelle Fleury
- Maisonneuve-Rosemont Hospital, Institute of Hematology, Oncology and Cell Therapy, Montreal University, Montreal, Canada
| | - Richard Greil
- Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute-CCCIT, and Cancer Cluster Salzburg, Salzburg, Austria
| | - Matthew Ku
- Department of Haematology, St Vincent's Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Reinhard Marks
- University Hospital Freiburg Internal Medicine I, Freiburg im Breisgau, Germany
| | - Kibum Kim
- University of Utah, Salt Lake City, UT, USA
- University of Illinois at Chicago, Chicago, IL, USA
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna, Bologna, Italy
| | - Judith Trotman
- Haematology Department, Concord Repatriation General Hospital, University of Sydney, Concord, NSW, Australia
| | | | | | | | | | | | - Raul Cordoba
- Department of Hematology, Fundacion Jimenez Diaz University Hospital, Health Research Institute IISFJD, Madrid, Spain
| | - Georg Hess
- Department of Hematology, Oncology and Pneumology, University Medical School of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Gilles Salles
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Rattanathammethee T, Norasetthada L, Bunworasate U, Wudhikarn K, Julamanee J, Noiperm P, Lanamtieng T, Phiphitaporn P, Navinpipat M, Kanya P, Jit-Ueakul D, Wongkhantee S, Suwannathen T, Chaloemwong J, Wong P, Makruasi N, Khuhapinant A, Prayongratana K, Niparuck P, Kanitsap N, Suwanban T, Intragumtornchai T. Outcomes of polatuzumab vedotin-containing regimens in real-world setting of relapsed and or refractory diffuse large B-cell lymphoma patients: a matched-control analysis from the Thai Lymphoma Study Group (TLSG). Ann Hematol 2023:10.1007/s00277-023-05273-8. [PMID: 37202499 DOI: 10.1007/s00277-023-05273-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023]
Abstract
Relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL) is a challenging condition to treat, and there is an unmet clinical need for effective therapies. Recently, polatuzumab vedotin (Pola), an anti-CD79b antibody-drug-conjugate (ADC), combined with bendamustine-rituximab (BR), has been approved for R/R DLBCL patients. However, real-world data on Pola-based regimens in R/R DLBCL patients, especially in Thailand, are limited. This study aimed to evaluate the efficacy and safety of Pola-based salvage treatment in R/R DLBCL patients in Thailand. Thirty-five patients who received Pola-based treatment were included in the study, and their data were compared to 180 matched patients who received non-Pola-based therapy. The overall response rate (ORR) in the Pola group was 62.8%, with complete remission and partial remission rates of 17.1% and 45.7%, respectively. The median progression-free survival (PFS) and overall survival (OS) were 10.6 months and 12.8 months, respectively. The study found a significantly higher ORR in Pola-based salvage treatments compared to non-Pola-based therapy (62.8% vs. 33.3%). The survival outcomes were also significantly superior in the Pola group, with longer median PFS and OS than the control group. Grades 3-4 adverse events (AEs) were mainly hematological, and they were tolerable. In conclusion, this study provides real-world evidence of the efficacy and safety of Pola-based salvage treatment in R/R DLBCL patients in Thailand. The results of this study are promising and suggest that Pola-based salvage treatment could be a viable option for R/R DLBCL patients who have limited treatment options.
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Affiliation(s)
- Thanawat Rattanathammethee
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Lalita Norasetthada
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Udomsak Bunworasate
- Division of Hematology and Center of Excellence in Translational Hematology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kitsada Wudhikarn
- Division of Hematology and Center of Excellence in Translational Hematology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jakrawadee Julamanee
- Hematology Unit, Division of Internal Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Panarat Noiperm
- Hematology Unit, Division of Internal Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Theerin Lanamtieng
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Pisa Phiphitaporn
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Manassamon Navinpipat
- Division of Hematology, Department of Medicine, Chulabhorn Hospital, Bangkok, Thailand
| | - Piyapong Kanya
- Division of Hematology, Department of Internal Medicine, Chiang Rai Prachanukroh Hospital, Chiang Rai, Thailand
| | - Dusit Jit-Ueakul
- Division of Hematology, Department of Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Somchai Wongkhantee
- Division of Hematology, Department of Medicine, Khon Kaen Hospital, Khon Kaen, Thailand
| | | | - Juthatip Chaloemwong
- Division of Hematology, Department of Internal Medicine, Nakornping Hospital, Chiang Mai, Thailand
| | - Peerapon Wong
- Division of Hematology, Department of Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Nisa Makruasi
- Division of Hematology, Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Archrob Khuhapinant
- Division of Hematology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kannadit Prayongratana
- Division of Hematology, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Pimjai Niparuck
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nonglak Kanitsap
- Division of Hematology, Department of Medicine, Thammasat University, Pathumthani, Thailand
| | - Tawatchai Suwanban
- Division of Hematology, Department of Medicine, Rajavithi Hospital, Bangkok, Thailand
| | - Tanin Intragumtornchai
- Division of Hematology and Center of Excellence in Translational Hematology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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11
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Song Y, Tilly H, Rai S, Zhang H, Jin J, Goto H, Terui Y, Shin HJ, Kim WS, Cao J, Feng J, Eom HS, Kim TM, Tsai XCH, Gau JP, Koh H, Zhang L, Song Y, Yang Y, Li W, Huang H, Ando K, Sharman JP, Sehn LH, Bu L, Wang X, Jiang Y, Hirata J, Lee C, Zhu J, Izutsu K. Polatuzumab vedotin in previously untreated DLBCL: an Asia subpopulation analysis from the phase 3 POLARIX trial. Blood 2023; 141:1971-1981. [PMID: 36626583 PMCID: PMC10646777 DOI: 10.1182/blood.2022017734] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/08/2022] [Accepted: 12/08/2022] [Indexed: 01/12/2023] Open
Abstract
In the phase 3 POLARIX study in previously untreated diffuse large B-cell lymphoma, polatuzumab vedotin combined with rituximab plus cyclophosphamide, doxorubicin, and prednisone (Pola-R-CHP) significantly improved progression-free survival (PFS) compared with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) with similar safety. Patients were randomized 1:1 to 6 cycles of Pola-R-CHP or R-CHOP plus 2 cycles of rituximab alone. For registration of POLARIX in China, consistency of PFS in an Asia subpopulation (defined as ≥50% of the risk reduction in PFS expected in the global population) was evaluated. Overall, 281 patients were analyzed: 160 patients from Asia in the intention-to-treat (ITT) population of the global study and 121 from an ITT China extension cohort. Of these, 141 were randomized to Pola-R-CHP and 140 to R-CHOP. At data cutoff (28 June 2021; median follow-up 24.2 months), PFS met the consistency definition with the global population, and was superior with Pola-R-CHP vs R-CHOP (hazard ratio, 0.64; 95% confidence interval [CI], 0.40-1.03). Two-year PFS was 74.2% (95% CI, 65.7-82.7) and 66.5% (95% CI, 57.3-75.6) with Pola-R-CHP and R-CHOP, respectively. Safety was comparable between Pola-R-CHP and R-CHOP, including rates of grade 3 to 4 adverse events (AEs; 72.9% vs 66.2%, respectively), serious AEs (32.9% vs 32.4%), grade 5 AEs (1.4% vs 0.7%), AEs leading to study treatment discontinuation (5.0% vs 7.2%), and any-grade peripheral neuropathy (44.3% vs 50.4%). These findings demonstrate consistent efficacy and safety of Pola-R-CHP vs R-CHOP in the Asia and global populations in POLARIX. This trial was registered at https://clinicaltrials.gov/ct2/home as # NCT03274492.
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Affiliation(s)
- Yuqin Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Hervé Tilly
- Centre Henri Becquerel and University of Rouen, Rouen, France
| | - Shinya Rai
- Kindai University Hospital, Osaka, Japan
| | - Huilai Zhang
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Jie Jin
- The First Affiliated Hospital of College of Medicine, Zhejiang University, Zhejiang, China
| | - Hideki Goto
- Department of Hematology, Hokkaido University Hospital, Sapporo, Japan
| | | | - Ho-Jin Shin
- Pusan National University Hospital, Busan, Republic of Korea
| | - Won Seog Kim
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Junning Cao
- Fudan University Shanghai Cancer Center, Shanghai, China
| | | | - Hyeon Seok Eom
- Center for Hematologic Malignancy, National Cancer Center, Goyang, Republic of Korea
| | - Tae Min Kim
- Seoul National University Hospital, Seoul, Republic of Korea
| | | | - Jyh-Pyng Gau
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hideo Koh
- Department of Hematology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Liling Zhang
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yongping Song
- Department of Hematology, Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Yu Yang
- Department of Lymphoma, Head and Neck Oncology, Fujian Cancer Hospital, Fuzhou, China
| | - Wei Li
- Department of Hematology and Oncology, The First Hospital of Jilin University, Jilin, China
| | - He Huang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Kiyoshi Ando
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan
| | | | - Laurie H. Sehn
- BC Cancer Centre for Lymphoid Cancer and The University of British Columbia, Vancouver, BC, Canada
| | - Lilian Bu
- F. Hoffmann-La Roche Ltd, Shanghai, China
| | - Xin Wang
- F. Hoffmann-La Roche Ltd, Shanghai, China
| | | | | | | | - Jun Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Koji Izutsu
- National Cancer Center Hospital, Tokyo, Japan
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12
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Nguyen TD, Bordeau BM, Balthasar JP. Mechanisms of ADC Toxicity and Strategies to Increase ADC Tolerability. Cancers (Basel) 2023; 15:713. [PMID: 36765668 PMCID: PMC9913659 DOI: 10.3390/cancers15030713] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
Anti-cancer antibody-drug conjugates (ADCs) aim to expand the therapeutic index of traditional chemotherapy by employing the targeting specificity of monoclonal antibodies (mAbs) to increase the efficiency of the delivery of potent cytotoxic agents to malignant cells. In the past three years, the number of ADCs approved by the Food and Drug Administration (FDA) has tripled. Although several ADCs have demonstrated sufficient efficacy and safety to warrant FDA approval, the clinical use of all ADCs leads to substantial toxicity in treated patients, and many ADCs have failed during clinical development due to their unacceptable toxicity profiles. Analysis of the clinical data has demonstrated that dose-limiting toxicities (DLTs) are often shared by different ADCs that deliver the same cytotoxic payload, independent of the antigen that is targeted and/or the type of cancer that is treated. DLTs are commonly associated with cells and tissues that do not express the targeted antigen (i.e., off-target toxicity), and often limit ADC dosage to levels below those required for optimal anti-cancer effects. In this manuscript, we review the fundamental mechanisms contributing to ADC toxicity, we summarize common ADC treatment-related adverse events, and we discuss several approaches to mitigating ADC toxicity.
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Affiliation(s)
- Toan D Nguyen
- Department of Pharmaceutical Sciences, University at Buffalo, Buffalo, NY 14214, USA
| | - Brandon M Bordeau
- Department of Pharmaceutical Sciences, University at Buffalo, Buffalo, NY 14214, USA
| | - Joseph P Balthasar
- Department of Pharmaceutical Sciences, University at Buffalo, Buffalo, NY 14214, USA
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13
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Mizuoka T, Sakamaki H, Fuji S, Saito S, Murata T, Ohno S, Inubashiri N, Oshima T, Yamamoto K. Cost-effectiveness of combination therapy of polatuzumab vedotin plus rituximab, cyclophosphamide, doxorubicin, and prednisolone for previously untreated diffuse large B-cell lymphoma in Japan. J Med Econ 2023; 26:1122-1133. [PMID: 37656225 DOI: 10.1080/13696998.2023.2254162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/02/2023]
Abstract
AIM The POLARIX trial showed that Pola + R-CHP (polatuzumab vedotin plus rituximab, cyclophosphamide, doxorubicin, and prednisolone) prolongs progression-free survival (PFS) in patients with previously untreated diffuse large B-cell lymphoma (DLBCL) compared with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone), the conventional standard of care, with a similar safety profile. However, Pola + R-CHP has not been evaluated from the viewpoint of health economics in Japan. This study evaluates the cost-effectiveness of Pola + R-CHP for previously untreated DLBCL from a Japanese public healthcare payer's perspective. METHODS A partitioned survival analysis model was constructed to estimate lifetime costs and effectiveness of Pola + R-CHP and R-CHOP in previously untreated DLBCL who had an International Prognostic Index score (IPI) score of ≥2. A parametric survival model was applied to data analyzed in the POLARIX trial to estimate the lifetime overall survival (OS) and PFS for each treatment. The parameters required for the model were based on the results of a literature search and expert opinion. RESULTS The incremental cost-effectiveness ratio (ICER) of Pola + R-CHP vs. R-CHOP was JPY2,710,238 per quality-adjusted life year (QALY), less than the ICER of JPY7.5 million per QALY that is considered to be cost-effective based on the threshold of the Japanese cost-effectiveness evaluation system. One-way sensitivity analysis showed that the parameters influencing the results of the analysis were median PFS and the total cost per regimen of salvage chemotherapy, patient weight, and patient age. Probabilistic sensitivity analysis showed that the probability of Pola + R-CHP having superior cost-effectiveness was 99.2% when the reference value was JPY7.5 million. The results of scenario analysis suggested that prolongation of PFS was an important factor in the evaluation of cost-effectiveness in previously untreated DLBCL with or without prolongation of OS. CONCLUSIONS This study suggests that Pola + R-CHP is a cost-effective treatment for previously untreated DLBCL in Japan under the public health insurance system.
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Affiliation(s)
- Takashi Mizuoka
- Medical Affairs Division, Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Hiroyuki Sakamaki
- Graduate School of Health Innovation, Kanagawa University of Human Services, Kanagawa, Japan
| | - Shigeo Fuji
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
| | - Shota Saito
- CRECON Medical Assessment Inc., Tokyo, Japan
| | | | - Shinya Ohno
- Medical Affairs Division, Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Naoki Inubashiri
- Medical Affairs Division, Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Tomoha Oshima
- Medical Affairs Division, Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
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14
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Miller SD, Lozano-Ortega G, Mutebi A, Briggs O, Sail K, Elliott B, Kalsekar A. Systematic review of outcomes and patient heterogeneity in relapsed or refractory diffuse large B-cell lymphoma. J Comp Eff Res 2023; 12:e220146. [PMID: 36417238 PMCID: PMC10288944 DOI: 10.2217/cer-2022-0146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022] Open
Abstract
Aim: To evaluate trials of systemic therapies in transplant-ineligible or -experienced, relapsed/refractory diffuse large-B cell lymphoma and the impact of patient characteristics on overall response rate (ORR). Patients & methods: Systematically reviewed multiple databases through 22 July 2021. Analyzed variations in patient characteristics and their relationship with ORR across trials. Results: Among 17 included trials, key patient characteristics varied substantially: primary refractory (0-69%), refractory to last line of therapy (LOT) (12-100%), ≥2 prior LOTs (14-100%), ≥3 prior LOTs (0-64%), IPI ≥3 (23-73%), tumor stage III/IV (50-90%) and median age (56-74 years). ORRs varied substantially (25-83%), correlating with these characteristics. Conclusion: Differences in patient characteristics significantly contribute to the variability in ORR across these trials and should be considered when contextualizing efficacy data.
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Affiliation(s)
- Sally D Miller
- Broadstreet HEOR, 201-343 Railway St, Vancouver, BC V6A 1A4, Canada
| | | | - Alex Mutebi
- Genmab, 777 Scudders Mill Road, Plainsboro, NJ 08536, USA
| | - Owanate Briggs
- Genmab, 777 Scudders Mill Road, Plainsboro, NJ 08536, USA
| | - Kavita Sail
- AbbVie, 1 N. Waukegan Road, Chicago, IL 60064, USA
| | - Brian Elliott
- Genmab, 777 Scudders Mill Road, Plainsboro, NJ 08536, USA
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15
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Shinmura K, Okubo S, Kadota S, Nakayama H, Sakurai A, Kurosawa S, Ito C, Aisa Y, Nakazato T. Polatuzumab vedotin plus bendamustine and rituximab (Pola-BR) was effective for neurolymphomatosis in a patient with refractory diffuse large B-cell lymphoma. Ann Hematol 2023; 102:223-5. [PMID: 36394579 DOI: 10.1007/s00277-022-05039-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 11/04/2022] [Indexed: 11/18/2022]
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16
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Wang Y, Jia S, Cao X, Ge S, Yu K, Chen Y. Application of next-generation sequencing in diffuse large B-cell lymphoma. Pharmacogenomics 2023; 24:59-68. [PMID: 36661028 DOI: 10.2217/pgs-2022-0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of invasive non-Hodgkin lymphoma. There is great heterogeneity in its molecular biological characteristics, clinical manifestations and prognosis. The use of rituximab has greatly improved the cure rate of DLBCL, but there are still 30% of patients with poor prognosis. In the era of precision medicine, the significance of molecular biology and genetic factors on the diagnosis, treatment and prognosis of patients has been found. Among these, next-generation sequencing technology plays an important role. This paper reviews the research progress of next-generation sequencing technology in the classification, diagnosis, prognosis and molecular targeted therapy of DLBCL.
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Affiliation(s)
- Yudi Wang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Suzhen Jia
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Xiubo Cao
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Shengchen Ge
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Kang Yu
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Yi Chen
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
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17
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Eltarhoni K, Kamel F, Ihebunezie K, Nisar P, Soloviev M. Therapeutic Antibodies in Cancer Treatment in the UK. Int J Mol Sci 2022; 23. [PMID: 36498915 DOI: 10.3390/ijms232314589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
The growing understanding of the molecular mechanisms of carcinogenesis accelerated the development of monoclonal therapeutic antibodies to specifically target multiple cancer pathways. Recombinant protein therapeutics now constitute a large proportion of yearly approved medicines. Oncology, autoimmune diseases and to a smaller degree the prophylaxis of organ transplant rejection are their main application areas. As of the date of this review, 37 monoclonal antibody products are approved for use in cancer treatments in the United Kingdom. Currently, the antibody therapeutics market is dominated by monoclonal immunoglobulins (IgGs). New types of recombinant antibody therapeutics developed more recently include bispecific recombinant antibodies and other recombinantly produced functional proteins. This review focuses on the approved therapeutic antibodies used in cancer treatment in the UK today and describes their antigen targets and molecular mechanisms involved. We provide convenient links to the relevant databases and other relevant resources for all antigens and antibodies mentioned. This review provides a comprehensive summary of the different monoclonal antibodies that are currently in clinical use primarily in malignancy, including their function, which is of importance to those in the medical field and allied specialties.
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18
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Kawasaki N, Nishito Y, Yoshimura Y, Yoshiura S. The molecular rationale for the combination of polatuzumab vedotin plus rituximab in diffuse large B-cell lymphoma. Br J Haematol 2022; 199:245-255. [PMID: 35764309 PMCID: PMC9796291 DOI: 10.1111/bjh.18341] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 01/01/2023]
Abstract
Polatuzumab vedotin (Pola) is an antibody-drug conjugate that targets the B-cell antigen CD79b and delivers monomethyl auristatin E (MMAE). It is approved in combination with bendamustine and rituximab (Rit) for relapsed/refractory diffuse large B-cell lymphoma (r/r DLBCL). Understanding the molecular basis of Pola combination therapy with Rit, the key component for the treatment of DLBCL, is important to establish the effective treatment strategies against r/r DLBCL. Here, we examined the rationale for the combination of Pola with Rit using Pola-refractory cells. We found that treatment with Pola increased CD20 expression and sensitivity to Rit-induced complement-dependent cytotoxicity (CDC) in several Pola-refractory cells. Pola treatment increased phosphorylation of AKT and ERK and both AKT- and MEK-specific inhibitors attenuated the Pola-induced increase of CD20 and CDC sensitivity, suggesting that these phosphorylation events were required for this combination efficacy. It was revealed that anti-CD79b antibody increased the phosphorylation of AKT but inhibited the phosphorylation of ERK. In contrast, MMAE potentiated phosphorylation of ERK but slightly attenuated the phosphorylation of AKT. Pola also increased CD20 expression on Pola-refractory xenografted tumours and significantly enhanced antitumour activity in combination with Rit. In conclusion, these results could provide a novel rationale for the combination of Pola plus Rit.
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Affiliation(s)
- Natsumi Kawasaki
- Product Research DepartmentChugai Pharmaceutical Co., Ltd.KamakuraKanagawaJapan
| | - Yukari Nishito
- Discovery Technology DepartmentChugai Pharmaceutical Co., Ltd.KamakuraKanagawaJapan
| | - Yasushi Yoshimura
- Product Research DepartmentChugai Pharmaceutical Co., Ltd.KamakuraKanagawaJapan
| | - Shigeki Yoshiura
- Product Research DepartmentChugai Pharmaceutical Co., Ltd.KamakuraKanagawaJapan
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19
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Takakuwa T, Okayama Y, Nakamae H, Kuno M, Makuuchi Y, Harada N, Okamura H, Nishimoto M, Nakashima Y, Koh H, Hino M. Polatuzumab vedotin combined with rituximab-bendamustine immediately before stem cell mobilization in relapsed diffuse large B-cell lymphoma. Ann Hematol 2022; 101:1609-1610. [PMID: 35218398 DOI: 10.1007/s00277-022-04803-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Teruhito Takakuwa
- Department of Hematology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Yusuke Okayama
- Department of Hematology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hirohisa Nakamae
- Department of Hematology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masatomo Kuno
- Department of Hematology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yosuke Makuuchi
- Department of Hematology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Naonori Harada
- Department of Hematology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hiroshi Okamura
- Department of Hematology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Mitsutaka Nishimoto
- Department of Hematology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yasuhiro Nakashima
- Department of Hematology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hideo Koh
- Department of Hematology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masayuki Hino
- Department of Hematology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
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20
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Perrone S, Lopedote P, Levis M, Di Rocco A, Smith SD. Management of relapsed or refractory large B-cell lymphoma in patients ineligible for CAR-T cell therapy. Expert Rev Hematol 2022; 15:215-232. [PMID: 35184664 DOI: 10.1080/17474086.2022.2044778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Chimeric antigen receptor T (CAR-T) therapy has revolutionized the treatment of relapsed/refractory large B-cell lymphoma (LBCL). However, patients who are excluded or have no access to CAR-T represent a challenge for clinicians and have generally a dismal outcome. The landscape for this category of patients is constantly evolving: new agents have been approved in the last 2-3 years, alone or in combination, and novel treatment modalities are under investigations. AREAS COVERED Thereafter, we reviewed the currently available therapeutic strategies: conventional chemotherapy, Antibody-drug conjugate ADC (mainly polatuzumab and loncastuxumab), bispecific antibodies (CD19/CD3 and focus on novel CD20/CD3 Abs), immunomodulatory drugs (covering tafasitamab and lenalidomide, checkpoint inhibitors mainly in PMBL), small molecules (selinexor, BTK and PI3K inhibitors), and the role of radiotherapy. EXPERT OPINION Navigating this scenario, will uncover new challenges, including identifying an ideal sequence for these therapies, the most effective combinations, and search for consistent predictive factors to help selecting the appropriate population of LBCL patients. At present, supporting clinical research for CAR-T ineligible patients, a new and challenging group, must remain a major focus that is complementary to advances in CAR T-cell therapy.
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Affiliation(s)
- Salvatore Perrone
- Hematology, Polo Universitario Pontino, S.M. Goretti Hospital, Latina, Italy
| | - Paolo Lopedote
- Internal Medicine, St Elizabeth's Medical Center, Boston University, Boston, U.S
| | - Mario Levis
- Department of Oncology, University of Torino, Torino, Italy
| | - Alice Di Rocco
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Stephen Douglas Smith
- Division of Medical Oncology, Department of Internal Medicine, University of Washington, Seattle, WA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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Terui Y, Rai S, Izutsu K, Yamaguchi M, Takizawa J, Kuroda J, Ishikawa T, Kato K, Suehiro Y, Fukuhara N, Ohmine K, Goto H, Yamamoto K, Kanemura N, Ueda Y, Ishizawa K, Kumagai K, Kawasaki A, Saito T, Hashizume M, Shibayama H. A phase 2 study of polatuzumab vedotin + bendamustine + rituximab in relapsed/refractory diffuse large B-cell lymphoma. Cancer Sci 2021; 112:2845-2854. [PMID: 33942442 PMCID: PMC8253277 DOI: 10.1111/cas.14937] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 12/21/2022] Open
Abstract
Polatuzumab vedotin (pola) is a CD79b‐targeted antibody‐drug conjugate delivering a potent antimitotic agent (monomethyl auristatin E) to B cells. This was an open‐label, single‐arm study of pola 1.8 mg/kg, bendamustine 90 mg/m2, rituximab 375 mg/m2 (pola + BR) Q3W for up to six cycles in patients with relapsed/refractory (R/R) diffuse large B‐cell lymphoma (DLBCL) who received ≥1 prior line of therapy and were ineligible for autologous stem cell transplantation (ASCT) or experienced treatment failure with prior ASCT. Primary endpoint was complete response rate (CRR) at the end of the treatment (EOT) by positron emission tomography–computed tomography (PET‐CT) using modified Lugano Response Criteria. Secondary endpoints included efficacy, safety, and pharmacokinetics. Thirty‐five patients (median age 71 [range 46‐86] years) were enrolled. Twenty‐three (66%) patients had refractory disease, and 23 (66%) had ≥2 prior lines of therapy. At a median follow‐up of 5.4 (0.7‐11.9) months, patients received a median of five treatment cycles. CRR was 34.3% (95% confidence interval [CI] 19.1‐52.2) at EOT. Overall response rate was 42.9% at EOT, and median progression‐free survival was 5.2 months (95% CI 3.6‐not evaluable). Median overall survival was not reached. No fatal adverse events (AEs) were observed. Grade 3‐4 AEs were mainly hematological: anemia (37%), neutropenia (31%), white blood cell count decreased (23%), thrombocytopenia/platelet count decreased/neutrophil count decreased (20% each), and febrile neutropenia (11%). Grade 1‐2 peripheral neuropathy (PN; sensory and/or motor) was reported in 14% of patients; there were no ≥grade 3 PN events. This study (JapicCTI‐184048) demonstrated the efficacy and safety of pola + BR in Japanese patients with R/R DLBCL who were ineligible for ASCT.
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Affiliation(s)
- Yasuhito Terui
- Department of Hematology and Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shinya Rai
- Department of Hematology and Rheumatology, Kindai University Hospital, Osaka, Japan
| | - Koji Izutsu
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Motoko Yamaguchi
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Mie, Japan
| | - Jun Takizawa
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Junya Kuroda
- Division of Hematology and Oncology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takayuki Ishikawa
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Koji Kato
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Youko Suehiro
- Department of Hematology, Kyushu Cancer Center, Fukuoka, Japan
| | - Noriko Fukuhara
- Department of Hematology and Rheumatology, Tohoku University Hospital, Miyagi, Japan
| | - Ken Ohmine
- Department of Hematology, Jichi Medical University Hospital, Tochigi, Japan
| | - Hideki Goto
- Department of Hematology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kazuhito Yamamoto
- Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital, Aichi, Japan
| | - Nobuhiro Kanemura
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Yasunori Ueda
- Department of Hematology, Kurashiki Central Hospital, Okayama, Japan
| | - Kenichi Ishizawa
- Department of Third Internal Medicine, Yamagata University Hospital, Yamagata, Japan
| | - Kyoya Kumagai
- Department of Hematology and Medical Oncology, Chiba Cancer Center, Chiba, Japan
| | | | | | | | - Hirohiko Shibayama
- Department of Hematology and Oncology, Osaka University Hospital, Osaka, Japan
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