Dr. Desai on Evolving Treatment Approaches in Lymphomas

Sameer Desai, MD, medical oncologist/hematologist, Regional Cancer Care Associates, discusses current and emerging treatment options under evaluation in lymphomas.

Lymphoma is a very broad category of disease, but among the most aggressive are large cell lymphomas, says Desai. To differentiate between the types of lymphomas and how aggressive they are, the use of molecular testing has become more pronounced in this space.

Although some patients receive standard R-CHOP, a regimen that has been used for years, others are receiving more aggressive approaches, depending on the type of tumor they have, says Desai. For example, those with more aggressive tumors might receive treatments via infusion for a lengthier duration of time. Currently, however, efforts are being focused on determining what the optimal treatment approach is for each patient.

Regarding second- and third-line treatment, newer options are emerging, such as CAR T-cell therapy. In October 2017, the FDA approved axicabtagene ciloleucel (axi-cel; Yescarta) as treatment for adults with relapsed or refractory non-Hodgkin lymphoma. The following year, in May 2018, the FDA approved tisagenlecleucel (Kymriah) for use in patients with large B-cell lymphoma.

Several companies that are now working on developing CAR T-cell therapeutic options with less associated toxicities, says Desai, as existing products result in 15% to 30% of patients experiencing neurotoxicity.