Dr. Nastoupil on Future Treatment Approaches in Large Cell Lymphoma

Loretta J. Nastoupil, MD, an assistant professor in the Department of Lymphoma/Myeloma at The University of Texas MD Anderson Cancer Center, discusses what treatment approaches she sees on the horizon in the landscape of large cell lymphoma. Nastoupil shared this insight in an interview during the 2016 OncLive State of the Science on Hematologic Malignancies.

Over the past 10 years, Nastoupil admits, researchers have struggled to improve upon the R-CHOP regimen, as many practitioners still consider that to be the standard of care for the majority of patients.

In an attempt to move forward, researchers have been looking for ways to identify high-risk patients who they believe will do poorly with R-CHOP. However, a preferred alternative has not been clearly established for these types of patients. What might be best, Nastoupil says, is for those patients to be considered for clinical trials. Here, they would be able to have access to novel agents that could hold promise. However, researchers are still awaiting results of an ongoing study to see if there is a better treatment option than R-CHOP. The study is a randomized trial of R-CHOP versus dose-adjusted EPOCH-R.

Oncologists are also still struggling with patients who are chemorefractory in terms of identifying alternative approaches that hold promise, but will also demonstrate improvement in survival. There are more promising options in the non-germinal subtype, based on the molecular profiling that’s been conducted. This demonstrates that there might be targeted agents that may be effective. What has been slightly disappointing, she explains, is the duration of response may not be as adequate as one would have hoped.

What seems to be promising at this time is the chimeric antigen receptor T-cell therapy for patients who are chemorefractory. However, this type of treatment does come with associated toxicities. Identifying the proper patient, and providing therapy that will be effective in minimizing or doing a better job of managing the toxicity, is still the goal for oncologists, she adds.