ViPOR: A New Regimen for Treating Aggressive Lymphoma?

Relapsed and refractory (R/R) aggressive B-cell lymphomas may respond to immunotherapeutic and targeted agents, but remissions are often incomplete and short-lived. Now, researchers investigated whether targeting multiple pathways with a combination of medications might improve remission rates.

In this single-center, phase 1b/2 trial, patients with R/R diffuse large B-cell lymphoma (DLBCL) received the oral agents venetoclax (a B-cell lymphoma 2 inhibitor), ibrutinib (a Bruton tyrosine kinase inhibitor), prednisone, and lenalidomide (an immunomodulatory agent) plus the anti-CD20 monoclonal antibody obinutuzumab. The regimen, referred to as ViPOR, was administered every 21 days for six cycles, with the oral drugs administered on days 1 through 14 (prednisone for 7 days) and obinutuzumab given intravenously on days 1 and 2. Prior treatment with these agents was allowed.

Among the 48 patients with evaluable data, the proportion with a complete response (CR) differed by DLBCL subtype: germinal center B-cell (GCB), 0/12; non-GCB, 8/13 (62%); double-hit MYC/BCL2, 8/15 (53%); and other, 2/8 (25%). A 2-year duration of response was seen in 65% of all responding patients and 78% of those who achieved CR. Grade 3–4 hematologic toxicities occurred in most patients; there was one case of grade-4 tumor lysis syndrome. Five patients stopped treatment because of adverse events, and 17% and 25% required dose reductions or delays, respectively.