选择的悖论:复发/难治性弥漫性大B细胞淋巴瘤的测序治疗。

IF 6.9 2区 医学 Q1 HEMATOLOGY
Taylor R. Brooks , Paolo F. Caimi
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引用次数: 0

摘要

自2017年以来,复发或难治性(R/R)弥漫性大B细胞淋巴瘤(DLBCL)的可用治疗方法发生了巨大变化。几十年来,基础科学和转化科学的不断进步导致了免疫肿瘤学的创新。在过去的10年里,这些创新最终获得了美国食品药品监督管理局的八项单独批准,用于治疗R/R DLBCL患者。高剂量治疗和自体干细胞移植(HDT-ASCT)仍然是符合移植条件的患者在最初缓解后复发的标准护理。对于不符合移植条件的患者或HDT-ASCT后复发的患者,存在多种选择。针对CD19的单克隆抗体、抗体-药物偶联物、双特异性抗体、免疫效应细胞产物和其他具有新作用机制的试剂现在可用于R/R DLBCL患者。嵌合抗原受体(CAR)T细胞越来越多地被用作DLBCL早期复发患者或对最初的化学免疫治疗难治的患者的二线治疗。这些策略的临床益处各不相同,并受患者和疾病特征以及既往治疗类型的影响。因此,临床医生在治疗R/R DLBCL时可能会遇到多种临床情况。药物的最佳顺序尚未确定,关于如何最好地订购这些药物,也没有基于证据的共识。这种丰富的选择带来了一个悖论:激增的治疗选择最初对患者和提供者来说是一种福音,但随着选择的进一步增加,它们不再解放。相反,更多的选择使R/R DLBCL的管理更具挑战性,因为缺乏药物之间的直接比较,并且希望最大限度地提高患者的疗效。在这里,我们对最近批准的二线和后续药物进行了综述,总结了详细说明这些药物使用的真实世界数据,并为R/R DLBCL的测序治疗提供了框架。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A paradox of choice: Sequencing therapy in relapsed/refractory diffuse large B-cell lymphoma

The available treatments for relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL) have experienced a dramatic change since 2017. Incremental advances in basic and translational science over several decades have led to innovations in immune-oncology. These innovations have culminated in eight separate approvals by the US Food and Drug Administration for the treatment of patients with R/R DLBCL over the last 10 years. High-dose therapy and autologous stem cell transplant (HDT-ASCT) remains the standard of care for transplant-eligible patients who relapse after an initial remission. For transplant-ineligible patients or for those who relapse following HDT-ASCT, multiple options exist. Monoclonal antibodies targeting CD19, antibody-drug conjugates, bispecific antibodies, immune effector cell products, and other agents with novel mechanisms of action are now available for patients with R/R DLBCL. There is increasing use of chimeric antigen receptor (CAR) T-cells as second-line therapy for patients with early relapse of DLBCL or those who are refractory to initial chemoimmunotherapy. The clinical benefits of these strategies vary and are influenced by patient and disease characteristics, as well as the type of prior therapy administered. Therefore, there are multiple clinical scenarios that clinicians might encounter when treating R/R DLBCL. An optimal sequence of drugs has not been established, and there is no evidence-based consensus on how to best order these agents. This abundance of choices introduces a paradox: proliferating treatment options are initially a boon to patients and providers, but as choices grow further they no longer liberate. Rather, more choices make the management of R/R DLBCL more challenging due to lack of direct comparisons among agents and a desire to maximize patient outcomes. Here, we provide a review of recently-approved second- and subsequent-line agents, summarize real-world data detailing the use of these medicines, and provide a framework for sequencing therapy in R/R DLBCL.

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来源期刊
Blood Reviews
Blood Reviews 医学-血液学
CiteScore
13.80
自引率
1.40%
发文量
78
期刊介绍: Blood Reviews, a highly regarded international journal, serves as a vital information hub, offering comprehensive evaluations of clinical practices and research insights from esteemed experts. Specially commissioned, peer-reviewed articles authored by leading researchers and practitioners ensure extensive global coverage across all sub-specialties of hematology.
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