While the combination of rituximab with the CHOP regimen (cyclophosphamide, doxorubicin, vincristine, and prednisone) has significantly improved DLBCL patient outcomes and led to cures in many patients, about 30-40% of patients are at risk for their disease rapidly escalating or relapsing after their initial chemotherapy treatment. To combat these relapse rates, more effective therapies are needed to ensure that more patients are able to achieve a cure.

A New Treatment Combination

Previously, the most common treatment for DLBCL has been R-CHOP. On April 19th, 2023, the FDA approved polatuzumab vedotin-piiq (Polivy) as an added medication to this combination, calling it pola-R-CHP. The medication vincristine was excluded from the regimen to avoid any overlapping neurologic toxic effects with the addition of Polivy. Polivy is a first-in-class anti-CD79b antibody-drug conjugate. The CD79b protein is expressed specifically in the majority of B cells which are the types of cells affected in DLBCL. This therapy delivers an anti-cancer drug to the B cell by attaching to the CD79b protein, causing the cell to die.

The addition of Polivy has significantly improved progression-free survival (PFS), a measure that refers to the time from treatment initiation to the occurrence of disease progression or death.

“It has been nearly 20 years since a new treatment option has become available to people newly diagnosed with diffuse large B-cell lymphoma,” Levi Garraway, MD, PhD, chief medical officer and head of global product development at Roche, stated in a news release. “Today’s decision from the FDA to approve Polivy in combination with R-CHP in this setting brings a much-needed new treatment option which may improve outcomes and bring other benefits to many patients with this aggressive lymphoma.”

Possible Side Effects of Polivy

Polivy is a targeted therapy that is designed to deliver an anti-cancer agent specifically to the B cells. It is designed to find and kill B cells. Cancerous B cells and some healthy B cells will be affected. The side effects most commonly seen with this medication are:

• Nerve problems in the arms and legs
• Nausea
• Lack of energy
• Constipation or diarrhea
• Hair loss
• Redness or sores in the mouth, lips, throat or digestive tract

When is Polivy Used?

Polivy may be used in combination with bendamustine and a rituximab product for the treatment of adult patients with relapsed or refractory DLBCL after at least two prior therapies. It can now also be used in combination with rituximab, cyclophosphamide, doxorubicin and prednisone (R-CHP) for the treatment of adult patients who have previously untreated DLBCL, not otherwise specified (NOS) or high-grade B-cell lymphoma (HGBL) and who have an International Prognostic Index (IPI) of two or greater.

How Effective is Polivy? 

A recent study of 879 newly diagnosed DLBCL patients showed that the combination of Polivy with R-CHP therapy reduced the risk of DLBCL worsening or returning by 27% compared to the traditional R-CHOP treatment. At 2 years, 77% of Polivy/R-CHP patients did not experience a disease relapse, compared with 70% of patients on the R-CHOP regimen.