Chemo-Free Option for Frail Lymphoma Patients | Umberto Vitolo, MD

Hello, I'm Umberto Vitolo. I'm a Nematologist at Candiola Cancer Institute in Turin, Italy. At this meeting, I will present a study tomorrow in diffuse larvae cell lymphoma. As you know, the diffuse larvae cell lymphoma is a cancer that occurs more frequently in elderly people. The median age is around 70 years old. The standard treatment for diffuse larvae cell lymphoma is chemotherapy with addition of the standard monoclonal antibodies, rituximab, against a protein that expresses the cancer cell. Unfortunately, not so many elderly patients are able to receive this type of standard treatment because the chemotherapy could be poor tolerated by elderly people, mostly from elderly people with comorbidities like renal, lung and oncardiac concurrent diseases. So we designed a study devoted to this patient with diffuse larvae cell lymphoma over 75 years old or over 80 years old with some other diseases that preclude them to receive standard chemotherapy regimen. The study is a chemo-free treatment with a specific antibody that is called epcoritamab. It's called specific because these antibodies target the cancer cell from one side, on the other side target the normal immune cells and lead to activation of the immune cells that you have in your body and instruct this immune system to act against the cancer cell. Epcoritamab is given subcutaneously. It is already approved for diffuse larvae cell lymphoma and follicular lymphoma in the case of relapse or refractory setting in the cell line. So this is the first time in which we tested epcoritamab as a single agent as a monotherapy in elderly patients. We are all 66 patients with a median age of 82 years old 72 percent of the patients were more than 80 years old and one third of the patients were more than 85 years old. The disease was advanced with a spread disease in the body with stage 4 of more than 60 percent with poor risk features in more than 70 percent of the patients. The majority of the patients, 92 percent of the patients had at least three or more comorbidities conditions that mean that they could not receive standard chemotherapy. With this type of treatment with a immunotherapy single agent without chemotherapy in 66 patients the overall response rate was very high on the 70 percent in 62 percent of the patient they achieved the complete what we call a complete metabolic response that it means that the disease disappear completely when assessed by PET. The treatment was given with epcoritamab subcutaneously once a week for the first three cycles and then every month up to 12 cycles so the treatment duration is one year. With the follow-up of the patient one year around 55 percent of the patients are alive without disease after one year. This is a good result because in patients with diffuse lipid cell lymphoma that are more than 80 years old with standard treatment unfortunately the chance to be cured at one year is less than 30 percent. It's important of course to notice the tolerability of the patient of the treatment the tolerability is quite good because the most frequent reaction is what we call the cytokine release syndrome that is a sort of big flu with fever sometimes some patient a high potential but just occur at the first full dose of the antibody and then the majority of the patients that had these side effects resolved with the completely. Some other side effects are diarrhea and infection it's important to protect the patient against infection during the treatment with epcoritamab monotherapy. Of course this is a single arm study with only 66 patients treated so far but we plan to expand this experience in the future and with the possible running a randomized large phase 3 strategy that will involve the several hundreds of patients in order to improve the outcome of these poor prognosis patients that so far are really in need of treatment because they cannot tolerate standard chemotherapy and so we need novel agents to manage the lymphoma that is a curable disease in young but we also would like to have a curable treatment also for elderly patient. Thank you so much for your attention. If our videos have helped you in any way and you're able to please consider making a donation to help us continue this important work. Your gift will go three times as far when we reach $500,000 by the end of the year. Every contribution big or small makes a difference and we're deeply grateful for your support.