What are the first-line treatment options for newly diagnosed DLBCL, and why are they chosen?
Diffuse Large B-cell Lymphoma (DLBCL) is the most common subtype of lymphoma—and lymphoma itself is a pretty common cancer, the fifth most common in America. People don’t always realize that; they hear about the more famous cancers, but lymphoma is very common, and DLBCL is the most common type of it.
So, there are lots of patients with DLBCL every year, and in the frontline therapy setting, we are very lucky—it’s better than it used to be. It puts the majority of people into remission and actually cures the majority of people. That’s something we cannot say for most cancers, even when we have advanced-stage DLBCL.
The traditional frontline therapy for most people over the last 25 years has been this acronym we call R-CHOP. We should get a better acronym, but we’ve been using that one for decades now. R-CHOP, as you can kind of hear, is an alphabet soup of five different letters—each one representing a different therapy.
Some of them are very simple. “P” is just a pill—Prednisone. People take Prednisone for allergies, asthma, things like that, so it’s not too complicated. The “C,” “H,” and “O” are different types of chemotherapy. And the “R” is different—it’s not chemotherapy. It’s an immunotherapy that gets your immune system to go and kill cancer cells.
So, R-CHOP has been the standard for decades. And just in the last couple of years, we have a new frontline option that we use for some people. It has even more letters—it’s called Pola-R-CHP. Hard to pronounce because there’s no vowel, but you can hear that most of the letters are the same. The new addition, “Pola,” is another type of immune or targeted therapy. It stands for Polatuzumab vedotin—there’s no quiz on it, so you don’t have to memorize the name.
Pola-R-CHP has been shown to be a little bit better than R-CHOP for some patients with DLBCL, but maybe not for all patients.