Clinical Practice Insights Reveal the Complexity of Lymphoma Subtypes and Advances in First-Line Treatments: With Chandler Park, MD; and Joshua Brody, MD

Author(s):

Chandler Park, MD, MSc, FACP,Joshua Brody, MD, of Mount Sinai Hospital

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Chandler Park, MD and Joshua Brody, MD discusses treatment challenges posed by the diverse spectrum of lymphomas, ranging from indolent subtypes, to aggressive diseases like Burkitt lymphoma.

In this Oncology Unplugged discussion, Chandler Park, MD, a medical oncologist at Norton Cancer Institute in Louisville, Kentucky, and Joshua Brody, MD, director of the Lymphoma Immunotherapy Program at The Tisch Cancer Institute at Mount Sinai in New York, New York, explored the heterogeneity of lymphoma subtypes and the evolution of treatment paradigms across B-cell malignancies. They discussed the treatment challenges posed by the diverse spectrum of lymphomas, ranging from indolent subtypes, such as follicular lymphoma, to aggressive diseases like Burkitt lymphoma.

Dr Brody highlighted the ever-expanding classification of lymphomas, each requiring distinct therapeutic approaches. He emphasized the nuanced management of follicular lymphoma, distinguishing between grade 3A disease, which is often managed with active surveillance or watchful waiting, and grade 3B disease, which is treated more aggressively like diffuse large B-cell lymphoma (DLBCL).

The conversation also addressed the significant progress in frontline Hodgkin lymphoma management, marked by the incorporation of immune checkpoint inhibitors, such as nivolumab (Opdivo), into combination regimens. Dr Brody reflected on the phase 3 SWOG S1826 trial (NCT03907488), which demonstrated the superiority of nivolumab plus doxorubicin, vinblastine, and dacarbazine (AVD) over brentuximab vedotin plus AVD in advanced-stage classic Hodgkin lymphoma, offering improved efficacy and a favorable safety profile.

Shifting to DLBCL, Dr Brody outlined the evolving role of novel therapies, including the antibody-drug conjugate polatuzumab vedotin-piiq (Polivy), which generated modest improvements in progression-free survival in the phase 3 POLARIX trial (NCT03274492) when added to R-CHP (rituximab [Rituxan], cyclophosphamide, doxorubicin, and prednisone) vs standard R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) in this patient population. He noted that although the efficacy benefit with polatuzumab vedotin plus R-CHP was most pronounced in non-germinal center B-cell subtypes, treatment decisions remain individualized based on patient-specific factors.