World Lymphoma Day: Confronting challenges and spreading awareness

The need for advanced treatment options for lymphoma, the most common type of blood cancer in India, has become increasingly urgent. Diffuse Large B-cell lymphoma (DLBCL), the most aggressive form of non-Hodgkin lymphoma (NHL), alone accounts for around 25,000 new cases annually in the country. Despite existing treatments, nearly 40 per cent of DLBCL patients face relapse or disease progression, creating significant challenges for patients, their families,  and the healthcare system. 

However, there is renewed hope as the first FDA-approved therapy for first-line treatment of DLBCL in almost 20 years is now available in India. 

Challenges in diagnosis and treatment pathway 

While DLBCL is a highly treatable and potentially curable form of blood cancer, mortality remains concerning, particularly in patients with returning disease (relapse/refractory).  In India, nearly 30-40 per cent of people diagnosed with DLBCL do not survive for five years, which is worse than the global average. A significant issue in the treatment pathway is misdiagnosis and delayed referrals by general physicians,  which often result in compromised treatment efficacy.  

Limited progress has been made in improving patient outcomes in previously untreated DLBCL over the last two decades. While many patients are responsive to initial treatment, as many as four in ten people do not respond to initial treatment or relapse within two years after initial treatment. These patients face limited treatment options, which adds to the emotional and psychological toll on them and their families,  who live in constant fear of the disease returning.

A breakthrough after 20 years  

For the first time in nearly two decades, there has been an advancement in DLBCL  treatment with a new drug: Polatuzumab in combination with chemotherapy. This is the first FDA-approved therapy in nearly 20 years for the first-line treatment of DLBCL, a hard-to-treat disease and the most common form of NHL. Polatuzumab is a first-in-class anti-CD79b antibody-drug conjugate (ADC).  

Data from Polatuzunab trial data indicates a reduction of 27 per cent in risk of progression-free survival, disease progression or death compared to the existing standard of care of MabThera/Rituxan plus cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP)  

Since the adoption of chemotherapy in 2002, approximately 11 clinical trials have failed to demonstrate improved clinical outcomes for DLBCL. Polatuzumab’s success is a remarkable breakthrough. Globally, over 23,000 patients have been treated in the first-line setting, and the drug is now approved in more than 90 countries, underscoring its worldwide impact.  

Polatuzumab in combination with chemotherapy is now also a preferred regimen for first-line treatment of DLBCL treatment under the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology.

Meeting the unmet needs  

The best chance of preventing relapse in people with DLBCL is with effective and tolerable therapy at the time they are first diagnosed and have received no prior treatment. When subsequent therapy is needed,  the course of the disease tends to have worse outcomes.  

Polatuzumab, an antibody-drug conjugate (ADC), offers hope for such patients by targeting specific proteins on lymphoma cells and delivering cytotoxic agents directly to the cancer cell.  

Clinical data shows a 27 per cent reduction in the risk of progression, relapse or death in patients treated with  Polatuzumab in the first line. Furthermore, 77 per cent of patients treated with this therapy were progression-free for two years, providing a lifeline to those who previously had limited options. 

Dr S P Sanyal, Senior Consultant Hemato Oncologist, Fortis Hospital, Mulund said, “One of the most challenging aspects of treating DLBCL is the high rates of relapse, with nearly 40 per cent of patients experiencing disease progression and limited treatment options available in treating disease which has come back.  After 20 years, we are witnessing a breakthrough in DLBCL treatment with new drugs like Polatuzumab.  The addition of this new drug to first-line therapy offers new hope by improving patient outcomes.”