A Systematic Review of the Clinical Efficacy of Treatments in Relapsed or Refractory Diffuse Large B Cell Lymphoma
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ORIGINAL RESEARCH
A Systematic Review of the Clinical Efficacy of Treatments in Relapsed or Refractory Diffuse Large B Cell Lymphoma Per-Olof Thuresson . Nancy Vander Velde . Palvi Gupta . Jonathan Talbot
Received: August 19, 2020 / Accepted: September 14, 2020 Ó The Author(s) 2020
ABSTRACT Introduction: Novel treatment options are needed to improve outcomes in transplantineligible relapsed/refractory (R/R) diffuse large B cell lymphoma (DLBCL). This systematic literature review evaluated clinical evidence on treatments for patients with R/R DLBCL ineligible for, or relapsed following, stem cell transplantation. Methods: We assessed the feasibility of conducting an indirect treatment comparison (ITC) or network meta-analysis (NMA) to evaluate the relative efficacy and safety of polatuzumab vedotin in combination with ben-
damustine ? rituximab versus other relevant treatments. Results: Thirty-seven studies were identified, of which 20 were eligible [seven randomized, controlled trials (RCTs); 13 observational/single-arm trials]. Due to a lack of RCTs, an ITC/ NMA summary of the relative efficacy and safety of the treatment options was not possible. Only two of the seven RCTs had positive outcomes. Conclusions: These findings highlight the paucity of published RCTs to establish the comparative efficacy of treatments for transplant-ineligible R/R DLBCL and lack of standard of care in this setting. Keywords: Diffuse large B cell lymphoma; Polatuzumab vedotin; Systematic literature review
Electronic Supplementary Material The online version of this article (https://doi.org/10.1007/s12325020-01507-7) contains supplementary material, which is available to authorized users. P.-O. Thuresson (&) J. Talbot F. Hoffmann-La Roche Ltd, Basel, Switzerland e-mail: [email protected] N. Vander Velde Tulane University School of Medicine, New Orleans, LA, USA P. Gupta DRG Abacus, Bicester, UK
Adv Ther
Key Summary Points Why carry out this study? Outcomes for patients with diffuse large B cell lymphoma (DLBCL) who relapse or are refractory (R/R) to first-line treatment are poor, especially those who are ineligible for stem cell transplantation (a standard second-line treatment). The aim of our clinical systematic literature review was to identify clinical evidence on treatment options for these patients and to assess the feasibility of conducting an indirect treatment comparison (ITC) or network metaanalysis (NMA) to evaluate the relative efficacy and safety of polatuzumab vedotin plus bendamustine-rituximab (pola-BR; a recently approved second-line or later treatment) versus other treatments for R/R DLBCL. What was learned from this study? Thirty-seven studies were identified, of which 20 were eligible. Due to a lack of randomized controlled trials (RCTs; seven in total), an ITC/NMA summary of the relative efficacy and safety of the treatment options was not possible, and only two of the seven RCTs had positive outcomes. These results highlight the lack of published RCTs to establish the comparative efficacy of tr
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