Dr Jason Romancik on Novel Lymphoma Therapies, Increasing Costs of Care

Jason Romancik, MD, a board-certified hematologist at Emory Winship Cancer Institute and assistant professor in the Department of Hematology and Medical Oncology at Emory University School of Medicine, discusses the current treatment landscape in aggressive lymphoma and drivers of high care costs.

Transcript

Can you speak to some of the drivers of high costs in cancer care, particularly in lymphoma?

I think that, while we have a lot of exciting new medications and treatment modalities coming to the fore for treating lymphoma, a lot of this stuff is a lot more expensive than some of the traditional chemotherapy that we've used in the past for several decades. So, no doubt that drug costs are driving some of the increased costs of cancer care.

Another thing to consider is we also have newer treatments like CAR [chimeric antigen receptor] T-cell therapy, which, sometimes we need to have patients in the hospital for this. There's other costs associated with some of these treatment modalities other than the cost of the drug or the product itself. I think all of that together is certainly coming together to bring the costs of lymphoma care higher and higher.

What does the current treatment landscape look like for aggressive lymphomas, and are there any novel therapies in the pipeline you think are especially promising?

The current treatment landscape for aggressive B-cell non-Hodgkin lymphoma—the most kind of common disease in that group is diffuse large B-cell lymphoma [DLBCL]. We've had some advances in the first-line treatment for DLBCL. For example, we've now started utilizing the drug polatuzumab vedotin into the frontline treatment of this disease, and there has been a progression-free survival benefit demonstrated with the addition of that compared to R-CHOP [cyclophosphamide, doxorubicin, prednisone, rituximab and vincristine]. But again, it's much more expensive than using the R-CHOP alone. So that's one advance over the past couple of years.

The other big shift is the CAR T-cell therapy that has started in the third-line and greater setting when we're treating DLBCL. It has more recently moved up to the second-line setting. It's been compared head-to-head with autologous stem cell transplant, which is the prior standard of care we use to treat patients with relapsed disease. So now patients who have an aggressive relapse that's very early after finishing their initial therapy, we'll be reaching for CAR T in most cases. I think those are the 2 big updates in terms of how we're treating this disease as a standard of care.

The big group of agents to keep an eye on moving forward are the bispecific antibodies. We have glofitamab, epcoritamab—those are 2 commercially available agents right now, and there's a lot of ongoing work trying to move those agents up into earlier lines of treatment, including the first-line setting. Depending on how those results look, we may be seeing even more changes in the standard-of-care therapy for DLBCL, so something to certainly keep an eye out for as we move forward.

How do novel therapies compare to historical standards of care in terms of cost?
A lot of the novel therapies we're using now to treat DLBCL—polatuzumab vedotin, CAR T-cell therapy, bispecific antibodies—are, in general, much more expensive than what we used to be doing.

For example, with the POLARIX study for first-line treatment of DLBCL, basically what we're doing is swapping out a chemotherapy drug called vincristine with a new antibody-drug conjugate called polatuzumab vedotin. That switch from chemo to a new monoclonal antibody does drive the cost of frontline treatment up significantly. The CAR T cell therapy, similarly, which we use in the relapsed setting right now, is much more expensive compared to autologous stem cell transplant, which, again, was just really just high-dose chemotherapy. There were some hospital costs associated with this, the kind of cell processing, but the CAR T-cell therapies are more expensive than what we used to do historically.

I think across the board, that's kind of been the theme—while we are improving clinical outcomes for patients, as time goes on, the cost is going up at a faster rate than, for example, the PFS [progression-free survival] improvements that we're seeing on these studies.