Low-grade non-Hodgkin lymphoma
The ZUMA-5 trial studied a CAR T-cell therapy called axicabtagene ciloleucel in 146 people with follicular lymphoma, nodal marginal zone lymphoma or extranodal marginal zone lymphoma who had experienced relapse after at least two previous courses of treatment.
Overall, more than 9 in 10 people who took part responded to treatment. Responses were generally long-lasting. Side effects were manageable, with a lower rate of serious side effects than in trials of axicabtagene ciloleucel in people with high-grade non-Hodgkin lymphomas.
The trial suggests that CAR T-cell therapy could be a promising treatment option for relapsed or refractory low-grade non-Hodgkin lymphoma.
High-grade non-Hodgkin lymphoma
The ZUMA-12 trial looked at the efficacy of axicabtagene ciloleucel in 32 people with ‘high risk’ high-grade B-cell lymphoma who had not been treated before. This included people with double-hit and triple-hit lymphoma and large B-cell lymphomas with features suggesting they are likely to be harder-to-treat.
Early results from the trial found that axicabtagene ciloleucel had a high response rate and a manageable side effect profile. The trial is ongoing.
Chronic lymphocytic leukaemia
The BRUIN trial is studying a drug called pirtobrutinib in people with relapsed or refractory B-cell non-Hodgkin lymphomas, CLL or SLL. Early results from people with CLL and SLL were presented at the BSH meeting.
Like some other treatments for CLL/SLL, pirtobrutinib blocks a protein called BTK (a ‘BTK inhibitor’). BTK is part of a pathway that helps B lymphocytes stay alive. Pirtobrutinib targets BTK more precisely than earlier BTK inhibitors, and binds to it more strongly. It is taken as a tablet once a day.
So far, 170 people with relapsed or refractory CLL/SLL have joined the BRUIN trial. On average, these people had had three previous courses of treatment. Most of them had been treated with a different BTK inhibitor before.
The trial found that pirtobrutinib demonstrated promising efficacy in people with relapsed or refractory CLL/SLL. It was effective in people who had had a different BTK inhibitor before. Response to treatment generally improved with continued treatment. Pirtobrutinib was well tolerated.
The trial is ongoing.
We have previous reported results of the pivotal ECHELON-2 trial, which found that brentuximab vedotin combined with CHP chemotherapy was significantly more effective than CHOP chemotherapy in people with previously untreated peripheral T-cell lymphoma.
At the BSH meeting, 5 year follow-up data was presented. This showed that brentuximab vedotin + CHP continued to provide clinically meaningful improvements in outcomes compared with CHOP. In particular, people with anaplastic large cell lymphoma (ALCL) who were treated with the brentixumab vedotin combination had a 34% reduction in the risk of death.
Some people with ALCL who relapsed after their first trial treatment went on to have treatment with brentuximab vedotin on its own. This included people in the brentuximab vedoting + CHP arm and the CHOP arm. Around 6 in every 10 of these people responded to brentuximab vedotin monotherapy, whether or not they had had treatment with brentuximab vedotin before.
A retrospective study of 205 people with advanced Hodgkin lymphoma compared escalated BEACOPP chemotherapy with a modified regimen where the procarbazine component of BEACOPP was swapped for dacarbazine (escalated BEACOPDac).
The study found that modifying the regimen in this way reduced toxicity without reducing efficacy. Escalated BEACOPDac could be a very effective option for advanced Hodgkin lymphoma.
To find out more about clinical trials for lymphoma, or to search for a trial that might be suitable for you, visit Lymphoma TrialsLink.
Date of publication: 5 July 2021