What Promising Treatments Are Available for Diffuse Large B-Cell Lymphoma Patients?

What Promising Treatments Are Available for Diffuse Large B-Cell Lymphoma Patients? from Patient Empowerment Network on Vimeo.

What promising diffuse large B-cell lymphoma (DLBCL) treatments are available for patients? Expert Dr. Nirav Shah from Medical College of Wisconsin shares an update on emerging research and patient types who may benefit from potential treatment approvals.

Dr. Nirav Shah is an Associate Professor at the Medical College of Wisconsin. Learn more about Dr. Shah.

[ACT]IVATION TIP:

“…understand their stage of disease and review the treatment options available for that stage and subtype of diffuse large B-cell lymphoma to best optimize the regimen to each individual patient.”

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Is Stem Cell Transplantation Still a Treatment Option for Some DLBCL Patients


Transcript:

Lisa Hatfield:

Dr. Shah, can you speak to some promising treatments that are available now for DLBCL patients? 

Dr. Nirav N. Shah:

Yeah, so while we consider DLBCL to be one disease, there is a lot of heterogeneity in it, and so there are sort of subtypes of DLBCL that we approach differently. And so the most well-known standard of care for DLBCL is a chemotherapy regimen called R-CHOP. It’s a five-drug regimen, it’s given once every three weeks for up to six cycles, again, depending on the stage, the presentation that the patient is in.

However, the goal has always been to do better than R-CHOP and there is an exciting new regimen called pola-R-CHP which gives you a drug called polatuzumab (Polivy) in lieu of an older drug called vincristine (Vincasar PFS), which is part of the R-CHOP regimen, and that regimen was tested head-to-head against R-CHOP chemotherapy and did have a slight improvement about a benefit of 5 percent to 6 percent in terms of its ability to induce a long-term remission, and again, that number may sound small, but every patient matters, and so that regimen, some of us have started adapting that, although I will note that that regimen is currently not FDA-approved, and so its accessibility and availability may be limited, although I’m optimistic that this regimen will be approved and become an option for the frontline for patients to come.

There are some types of diffuse large B-cell lymphoma that are a little bit more aggressive, we call some of these double-hit lymphomas, so a term that you may hear if you’re diagnosed and it’s something a doctor may talk about, and so for those patients, we often use a higher intensive regimen, the regimen that we use at our institution is a regimen called dose-adjusted EPOCH and so you can see here that it’s a little bit complicated, there are caveats here, there’s different treatment options available, and the number of treatments we give is partially based on how you present and the stage that you initially show up with. And so I think that it’s important to have a conversation with your physician. And so my activation tip for patients is to understand their stage of disease and review the treatment options available for that stage and subtype of diffuse large B-cell lymphoma to best optimize the regimen to each individual patient. 


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What Is the Ann Arbor Staging System for Diffuse Large B-Cell Lymphoma?

What Is the Ann Arbor Staging System for Diffuse Large B-Cell Lymphoma? from Patient Empowerment Network on Vimeo.

What is the diffuse large B-cell lymphoma (DLBCL) system called Ann Arbor staging? Expert Dr. Nirav Shah from the Medical College of Wisconsin explains how DLBCL differs from other blood cancers and symptoms that characterize each DLBCL stage.

Dr. Nirav Shah is an Associate Professor at the Medical College of Wisconsin. Learn more about Dr. Shah.

[ACT]IVATION TIP:

“…make sure they really understand their scan and what stage they are, and how that impacts the treatment that the doctor is offering.”

See More from [ACT]IVATED DLBCL

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How Are Bispecific Antibodies Being Used in Diffuse Large B-Cell Lymphoma Treatment?


Transcript:

Lisa Hatfield:

I know as a blood cancer patient, my number one question is, what stage do I have and what is my prognosis? So can you explain the staging system a little bit, I think it’s called the Ann Arbor staging system for DLBCL and then maybe prognoses that you may or may not feel comfortable giving to each patient.

Dr. Nirav N. Shah:

Yeah, so lymphoma is a little bit different, because it’s a blood cancer that involves lymph nodes, and so how we stage it is based on the location and the number of lymph nodes involved, if, for example, you had one lymph node in your neck, and that’s all you had, we would consider you to have stage I diffuse large B-cell lymphoma. If you had more than one lymph node, but on the same half of the body, thinking of your diaphragm as sort of a midpoint, we would then consider you to have stage II disease. If you have lymph nodes on both halves of the body, we would then consider you to have stage III disease, and if you have organ involvement, so bone marrow involvement, liver involvement, kidney involvement or lung involvement, we consider those patients to be stage IV.

Now, to a certain degree, the higher the stage, the worse the prognosis, but as I stated earlier, even patients with stage IV lymphoma can be cured, and that’s different than other cancers, right? When we think about stage IV colon or stage IV breast, many of those patients, we actually tell them that they’re in a non-curative setting, and so while the prognosis for stage III and IV is a little bit worse than those patients who have stage I to II disease, I do try to focus on that we do treat with curative intent, and we do alter our treatment regimens according to the stage of disease that they present with, and so my activation tip for patients in this setting is to make sure they really understand their scan and what stage they are, and how that impacts the treatment that the doctor is offering. 


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How Is Diffuse Large B-Cell Lymphoma Explained to a Newly Diagnosed Patient?

How Is Diffuse Large B-Cell Lymphoma Explained to a Newly Diagnosed Patient? from Patient Empowerment Network on Vimeo.

How do diffuse large B-cell lymphoma (DLBCL) experts explain this cancer to newly diagnosed patients? Expert Dr. Nirav Shah shares his perspective on how he leads patients through their diagnosis and treatment phases and key points that he shares to educate his patients.

Dr. Nirav Shah is an Associate Professor at the Medical College of Wisconsin. Learn more about Dr. Shah.

[ACT]IVATION TIP:

“…learn as much as they can about this diagnosis and take notes, because I know that often patients in that first visit don’t really register everything. Just because they’re feeling overwhelmed.”

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Why Is Clinical Trial Participation Vital for Diffuse Large B-Cell Lymphoma Patients


Transcript:

Lisa Hatfield: 

Okay. So, Dr. Shah, you have a patient that comes into your office newly diagnosed with DLBCL, maybe from their…or they’ve heard it from their primary care provider, they understand, they looked it up on the Internet, diffuse large B-cell lymphoma, they see the lymphoma, I would anyway, I’d see lymphoma, and I know it’s cancer. What’s included in your initial evaluation, how do you explain in basic terms to a newly diagnosed patient what DLBCL is? 

Dr. Nirav N. Shah: 

Yeah, great question, Lisa. I think that any time somebody gets that diagnosis with a cancer label on it, it’s incredibly overwhelming, and so what I try to do when I see my new patients is first simply just learn about them. How did this come about, what symptoms led to this diagnosis? Learn about their past medical history, which impacts how I might treat them and what options I’m going to give them, and sort of learn about who they are a little bit, learn about their family, what they do for a living, because I think those are important values to know about your patients, when trying to make a treatment decision.

What I try to explain to these patients is that DLBCL, yes, it is a cancer. Yes, it is, unfortunately, an aggressive cancer, one that can be very rapidly growing, but unlike a lot of cancers, it is a curable type of cancer, and I really try to highlight that like all cancers, unfortunately, not every single patient is cured with diffuse large B-cell lymphoma, but initially, I think there’s reason to have optimism and hope because the goal is, for me, when I meet a new DLBCL patient to provide a curative intent treatment approach for them.

As a part of that initial evaluation, we need to know more about where their disease is and in lymphoma. We often use a PET-CT, which is a special type of scan that sort of lights up areas that can be involved with lymphoma. In some cases, we do a bone marrow biopsy, although that is less indicated now because of how good the PET scans are, and then we talk about other testing, a lot of the chemotherapies can cause problems to your heart, so we often do an ultrasound of your heart to make sure it’s healthy enough to be able to tolerate some of the regimens that we consider for this disease, and then we talk about access in terms of how are we going to get the chemotherapy into the patient, and whether or not they would need a device like a port. But the main focus of the conversation is explaining the disease, teaching about the disease and focusing on that unlike other cancers, even stage III or IV diffuse large B-cell lymphoma is a curable entity, and the key is moving promptly getting the workup done in an efficient but complete manner and then initiating a treatment plan. 

Lisa Hatfield:

Right, thank you. And if you had one tip for patients when they first come in, what would you tell this patient that’s coming to see you in? 

Dr. Nirav N. Shah:

Yeah. I think my activation tip would be to learn as much as they can about this diagnosis and take notes, because I know that often patients in that first visit don’t really register everything. Just because they’re feeling overwhelmed.


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DLBCL Treatment and Research Updates Patients Should Know About

DLBCL Treatment and Research Updates Patients Should Know About from Patient Empowerment Network on Vimeo.

What diffuse large B-cell lymphoma (DLBCL) treatment and research updates should patients know about? Expert Dr. Amitkumar provides an overview of recent updates and shares credible resources to learn about emerging research.

Dr. Amitkumar Mehta is Director of the Lymphoma Program and CAR T Program and Medical Director of the Clinical Trials Office at O’Neal Comprehensive Cancer Center at UAB. Learn more about Dr. Mehta.

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Why Should DLBCL Patients Feel Empowered to Speak Up?

Transcript:

Katherine:

The annual American Society of Hematology, or ASH, meeting happened recently, where DLBCL experts shared their research. Are there updates that patients should know about?

Dr. Mehta:

Absolutely. There are so many promising agents that were presented in a wide variety of different clinical trials, early phase or Phase I, Phase II, and also some of the advanced studies that were discussed. The promising right now, I say in a relapse setting, potentially curative is the CAR T. There was some long-term data, a newer platform of CAR T therapy, autologous, that means where patient’s own T cells have modified. There are quite many products already approved. Their long-term data, safety, and efficacy was discussed – very impressive. The new set of cellular therapy, which includes not only CAR T but other immune cell like NK cell therapy, which are also presented – very impressive. Now, remember, we need to auto our own CAR-T cells being processed. There is a time lag, about two or three weeks for preparing those cells compared to the others they’re over the shelf.

Of course, all of this data are early, but they are very promising going forward. The others are bispecific antibodies. So, so far what we have is the monoclonal antibodies targeting single antigen like CD20 or CD19. But now we have bispecific, which targets CD20 on one end but CD3, the T-cell antigen on the other end. And those antibodies have proven very effective in all B-cell lymphoma and large-cell lymphoma.

And there are so many other agents in early phase. As we go out more in-depth going forward, we will lower their efficacy and side effects and how they fare compared to the other approved agents. So, very exciting time for lymphoma patients. So, that even if it comes back, we have multiple options to have it back in remission and potentially a cure going forward.

Katherine:

Yeah. No, that’s great. How can patients learn more about emerging research?

Dr. Mehta:

Very important question. And currently, as we were discussing, Googling sometimes is not the right way because it is unfiltered information. And its sample size could be different. Somebody has a negative experience, and they would write that, and the person reading might have a different perception of the diagnosis and treatment. There are good websites, American Society of Hematology, American Society of Clinical Oncology, Lymphoma & Leukemia Society.

There are many other cancer societies. They have good information available. But the most important is actually the responsibility, in my opinion, lies on the provider. When the patient comes and sees me, I make sure that I share the information with the patient. And I direct them to the right source of information, and it should be interactive.

That means if they read something if they have any questions, they come back and ask me. At the end, it is our responsibility as a care team to be available, first of all, for any questions and provide right information. What I’ve learned through a period of time that that has helped patient quite a bit all across so that they don’t have to wander around for nonspecific information like on Google or other search platforms

DLBCL Treatment Approaches for Newly Diagnosed and Relapsed/Refractory Patients

DLBCL Treatment Approaches for Newly Diagnosed and Relapsed/Refractory Patients from Patient Empowerment Network on Vimeo.

What are current diffuse large B-cell lymphoma (DLBCL) treatment approaches for newly diagnosed and relapsed/refractory patients? Expert Dr. Amitkumar Mehta outlines treatment options, explains how treatments have evolved, and discusses patient monitoring following treatment completion.

Dr. Amitkumar Mehta is Director of the Lymphoma Program and CAR T Program and Medical Director of the Clinical Trials Office at O’Neal Comprehensive Cancer Center at UAB. Learn more about Dr. Mehta.

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Transcript:

Katherine:

What treatment options are available for DLBCL patients?

Dr. Mehta:

So, it’s a very loaded question because, you know, front-line and relapse and field has evolved immensely over a period of years. But I’ll tell you that in a new diagnosis of DLBCL, still R-CHOP or R-EPOCH-based treatments are standard of care. We have – as a medical community, we have tried multiple times to improve upon the foundation of R-CHOP or R-EPOCH. But we have failed, unfortunately, that R-CHOP is still the best treatment.

There are multiple clinical trials, which are building on R-CHOP adding novel agents and see whether it gets better or not. So, therefore, when we discuss, we discuss always to ask about whether there is any clinical trial option. If the DLBCL comes back, which happens in about 30 to 40 percent of cases, there are so many treatment options.

There are novel options including bone marrow transplant. The CAR-T treatment, tafasitamab (Monjuvi), different CD19-directed therapies, or loncastuximab (Zynlonta) CD19-directed antibody drug conjugate. There are so many – polatuzumab (Polivy) – options available. Therefore, it is important to have a discussion with your provider that “Okay. Well, if it has come back, of course, it is disappointing. But what are my options, clinical trial options, novel therapeutic options,” so that we can work as a team with betterment and hoping to cure even if it has come back, a large cell lymphoma.

So, there are so many treatment options out there. I did not touch upon the clinical trial. There are so many clinical trials going on within amazing agents, which are very effective in DLBCL.

Katherine:

How are DLBCL patients monitored after treatment is completed?

Dr. Mehta:

Very importantly, if you go in remission and after the initial treatment or in a relapse setting, we have to keep an eye. And, of course, we want to detect if it comes earlier so that we can start the treatment earlier. Typically, in the beginning, in the initial two years, the follow-up could be closer, every four to six months we get together.

We have labs done. Sometimes we do scans, making sure that a lymphoma – there is no evidence of it coming back. So, the initial two to three years the follow could be closer. And then, as we space out, the follow spaces out further. And then, after you have a five-year mark where the lymphoma has not come back, the chance of it coming back goes further down. So, then I start follow-up annually on those patients. Yeah.

Why Should DLBCL Patients Feel Empowered to Speak Up?

Why Should DLBCL Patients Feel Empowered to Speak Up? from Patient Empowerment Network on Vimeo.

Why is it vital for diffuse large B-cell lymphoma (DLBCL) patients to engage in their care? Expert Dr. Amitkumar explains the importance of speaking up and the value of considering a second opinion.

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Transcript:

Katherine:

Why should patients feel empowered to speak up?

Dr. Mehta:

So, that is very, very important because at the end, anybody and the patient is in the center. As we talked about their preferences, shared decision-making, they need to speak up because, at the end, I need to know, we need to know as a care team their preferences, right? Who is going to be my support? Who’s going to be with me? Maybe they might have to move somewhere to get the treatment, right? Or sometimes I bring up and I have so many patients who actually brought up “Well, I have a trip planned on this date,” right, or “I have a graduation planned,” or “I have son or daughter’s wedding planned,” right?

So, they should feel empowered to speak up. Yes, they’re shocked at the first instance because of their diagnosis of cancer. But that part after sharing all the information about cancer and treatment, it eases up a little bit. Then they feel “Okay, it is not end of the road,” right? “I’m going to fight it out.” But at the same time, there are important life events planned. So, they need to speak up, not only for that but also, as we talked about, preferences, their choices about the clinical trial.

Sometimes it is okay to ask whether I can go for another opinion, especially now in many institutions there are specialists who just focus on lymphomas, right? In that case, it is okay to ask whether – anywhere else I should go for an opinion and see whether I have more options. So, patient is always in center. And I feel always comfortable when patients speak up, and I make sure that “Yes, I will make sure that whatever the preference is, I will try to meet those preferences.”

How Can DLBCL Patients Benefit From Shared Decision-Making?

How Can DLBCL Patients Benefit From Shared Decision-Making? from Patient Empowerment Network on Vimeo.

What is shared decision-making, and how can it help diffuse large B-cell lymphoma (DLBCL) patients? Expert Dr. Amitkumar Mehta explains the process and shares key questions to ask about treatment and care. 

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Transcript:

Katherine:

What is shared decision-making, and how does it work?

Dr. Mehta:

Shared decision-making has evolved over the last couple of decades.

And exactly as we were talking about the treatment, this is – I always share with my patient that we are on your side, right? We are with you. We are part of your journey. And, of course, for anyone, this could be a brand-new journey, right? So, each person is different. Each person’s preference is different, right? In that case, when I have the details of whether it’s lymphoma or treatment, they also have input. They might have read somewhere. They might have a family member who had gone through the chemotherapy, and they have preferences, let’s say.

So, when we sit down and discuss that time, they also have an input on that. Write appropriate questions, you know. What is my diagnosis? What stage it is, right, whether it’s high risk or low risk? What are the potential for cure, right? What kind of chemotherapy you’re looking at, whether I have more options in that like clinical trial, right?

Yes, you said you were going to treat me with standard of care. Do I have an option of clinical trial? Like in DLBCL setting, R-CHOP, or R-EPOCH, which is the foundation of DLBCL treatment for so long. What is happening in the clinical trial is we are building on that foundation. We are building on the standard of care. So, there could be a potential that you are an eligible patient for X, Y, Z clinical trial, where you’re getting an added novel immunotherapy drug or a bispecific antibody.

Why you’re doing that to see whether we can improve upon whatever we have. So, in that, if patient is informed, they can also be a part of the conversation, right? It is just like when we go for, say, buying a car. It is not that a dealer is showing us a car, and we say, “Okay, I’ll go with it.” No, we say, “What color it is? I want this color. I want this seat. I want this model.”

I mean, that is a shared decision-making, right? And then we come to a conclusion. “Okay, this is the car that I prefer, I’m comfortable with, and I’m going to buy that.” It’s similar in cancer care.

Tools for Setting DLBCL Treatment Goals

Tools for Setting DLBCL Treatment Goals from Patient Empowerment Network on Vimeo.

Expert Dr. Amitkumar Mehta shares key steps for collaborating on diffuse large B-cell lymphoma (DLBCL) treatment goals with your healthcare team.

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Transcript:

Katherine:

When someone is considering DLBCL treatment, what advice do you have for setting treatment goals with their healthcare team?

Dr. Mehta:

So, for any cancer and particularly DLBCL, the understanding of DLBCL is very, very important. So, what we do in our clinic, and I think it should it be a very standard process all across, is when I sit down with a patient with a new diagnosis of DLBCL, obviously, they’re in shock, number one. Number two, remember, if you go back 10 to 15 years, we did not have this much information. Now, you can Google it and find so much information.

It may be a positive, may be a negative. And, within a day, you are expert in DLBCL, right? But that’s not how it should be. So, the most important part, in the first visit, I sit down with my patient for an hour, hour-and-a-half. It’s an overwhelming visit for them, because I share a lot of information with them. So, the first thing is information. Second thing is trust with your team. It’s not just me. It’s my nurse. It’s my nurse practitioner. What is infusion center? What is a PET scanner? What I’m going to get as chemotherapy? What is the treatment looks like? So, all of this is a very important information.

And I always leave a door open that first visit. Don’t get overwhelmed. You may come back if you have more questions. Write down those questions, and we will discuss that again. And then it’s more afterwards. They can call to the clinic. They can send a message, and we’ll respond. So, I think when we have all this information, they know the whole layout, right?

It is just like – say, we are planning a vacation. We are going for – somewhere out of country, right? So, what we need to know. Where we are going information, flight details, hotel details, currency, everything. If you have that, then you are at ease. That I know the whole treatment plan. I know what’s going to happen when, expected timelines. I also know what are the potential side effects to the treatment. And, of course, what is the intent of the therapy, right? It may be a cure.

In DLBCL setting, 60 percent of patients will be cured. All of that information is a treatment plan, and that has to be very transparent and open with the patient so that they feel comfortable that what I’m going through, when things will happen, who are people in the care team that I can approach if I have any questions?

An Expert’s Perspective on What It Means to Thrive With DLBCL

An Expert’s Perspective on What it Means to Thrive With DLBCL from Patient Empowerment Network on Vimeo.

What does it mean to thrive with diffuse large B-cell lymphoma (DLBCL)? Expert Dr. Amitkumar Mehta shares how patients often adjust to their diagnosis and provides advice that can help them thrive.

Dr. Amitkumar Mehta is Director of the Lymphoma Program and CAR T Program and Medical Director of the Clinical Trials Office at O’Neal Comprehensive Cancer Center at UAB. Learn more about Dr. Mehta.

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Transcript:

Katherine:

Dr. Mehta, welcome. Would you please introduce yourself?

Dr. Mehta:

I’m Amitkumar Mehta. I am the Director of Lymphoma Program and CAR T Program at the O’Neal Comprehensive Cancer Center at University of Alabama in Birmingham. I’m also Medical Director of Clinical Trial Office at UAB.

Katherine:

Great. Thank you so much for joining us today.

Dr. Mehta:

Thank you.

Katherine:

In your opinion, what does it mean to thrive with DLBCL?

Dr. Mehta:

Katherine, it’s really important question because the cancer is – we in our clinic call this a C word. And it is very dangerous, shocking most of the time. When somebody’s diagnosed with cancer, their whole life changes. And, in that, the first reaction is shock, that “Why me? Why this happen to me?” And either you’re a mother, you are a father, or many other roles that we have in our life. Everything kind of pauses.

And then it takes a little while for them to kind of understand the situation and kind of reset in a fight mode. And then everything changes. The other important thing is information about a cancer or any cancer as a matter of fact. Then we kind of assess the situation, assess the treatment options, which are plenty. And then we go in a mode that we want to fight it out. We see the light at the end of the tunnel. This all helps to kind of thrive in that situation.

But for that, the most important part is the information of the cancer, information about the treatment. And that way we can get together ourself and we can say that “Now I’m ready to fight whatever it may come in.” Many people cling to faith. Many people cling to their family. Many people cling to their support to have that mode of fight with a cancer.

And I say that, if all of this has – it’s kind of a recipe – if it all comes together, then you can thrive well throughout the whole – the phase of diagnosis to treatment to – if you’re cured, in a subsequent part of your life.

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