Following the release of our latest ebook, this is the first blog post in this series focusing on Diffuse Large B Cell Lymphoma, the most common form of Non Hodgkin Lymphoma (NHL). The DLBCL market is experiencing considerable growth; it is predicted to reach a size of almost USD 4.3 billion by 2022.
The insights shared here, and in the eBook that you can download for free
DLBCL is an aggressive cancer of infection-fighting lymphocytes (white blood cells) characterized by rapid enlargement of lymph nodes. So-called “B-symptoms” include fever, night sweats, and unexplained weight loss.
Although diffuse large B-cell lymphoma is the most common sub-type of non-Hodgkin lymphoma, it is easily classified as an orphan disease. Its annual incidence in western countries is roughly 3.8 per 10,000 inhabitants. For 2020, this ratio translates into approximately 1,250 new patients each in the EU5 and in the US.
Left untreated, the disease can quickly lead to death. Fortunately, DLBCL is highly responsive to treatment, and a large percentage of patients never experience relapse.
|
Regimen |
Definition |
|
ACVBP +/-R |
doxorubicin, cyclophosphamide, vindesine, bleomycin, prednisone, |
|
Benda +/-R |
bendamustine |
|
CHOP +/-R |
cyclophosphamide, doxorubicin (hydroxydaunorubicin), vincristine (Oncovin), and prednisone |
|
CHOP 14 +/-R |
(Same as CHOP but shortened treatment interval) |
|
DHAP +/-R |
dexamethasone, high-dose ara-c, cisplatin (platinol) |
|
EPOCH +/-R |
etoposide phosphate, prednisone, vincristine sulfate (Oncovin), cyclophosphamide, doxorubicin (hydroxydaunorubicin) |
|
ESHAP +/-R |
etoposide, solu-medrol, high-dose ara-c, cisplatin (platinol) |
|
GDP +/-R |
gemcitabine, dexamethasone, cisplatin (platinol) |
|
GEMOX +/-R |
gemcitabine, oxaliplatin |
|
ICE +/-R |
ifosfamide, carboplatin, etoposide |
|
mini CHOP +/-R |
(Same as CHOP but dose-adjusted down for elderly/frail patients) |
|
Pixa |
Pixantrone |
In addition to chemotherapy regimens, the European Medicine’s Agency (EMA) and the US Food and Drug Administration (FDA) have approved several branded drug therapies for the treatment of DLBLC. Table 2 lists these regimens in order of first regulatory approval. AplusA’s market tracker reports that so far, except for rituximab and bendamustine, usage of branded therapies within the DLBCL market is negligible.
|
Generic name |
Marketer / Brand |
Class of therapy |
Approval date |
|
General R/R DLBCL usage |
|
rituximab |
EU: Roche’s MabThera US: Biogen/ Genentech’s Rituxan EU/US: Biosimilars |
CD20-directed cytolytic antibody |
June 1998 |
Nov. 1997 |
Combined with chemotherapy or as a single-agent for low-grade DLBCL |
|
ibritumomab tiuxetan |
Aurobindo’s Acrotech division’s Zevalin |
CD20-directed radiotherapeutic antibody |
Jan. 2004 |
Feb. 2002 |
EU: After rituximab US: R/R low-grade b-Cell non-Hodgkin’s lymphoma |
|
bendamustine |
EU: Mundipharma/ Astellas’ Levact/ Ribomustin/ Ribovact US: Eagle/ Teva’s Treanda/ Bendeka/ Belrapzo |
Bifunctional mechlorethamine derivative (chemotherapy) |
July 2010 |
March 2008 |
After rituximab |
|
pixantrone |
Servier/ CTI Biopharma’s Pixuvri |
Anthracycline (chemotherapy) |
May 2012 |
N/A |
EU: As monotherapy for multiply relapsed or refractory aggressive disease US: Not approved |
|
tisagenlecleucel |
Novartis’ Kymiriah |
CD19-directed autologous CAR T-cell immunotherapy |
Aug. 2018 |
Aug. 2017 |
For specific DLBCL sub-types After two or more systemic therapies |
|
axicabtagene ciloleucel |
Gilead/ Kite’s Yescarta |
CD19-directed autologous CAR T-cell immunotherapy |
Aug. 2018 |
Oct. 2017 |
For specific DLBCL sub-types after two or more systemic therapies |
|
polatuzumab vedotin |
Roche/ Genentech’s Polivy |
CD79b-directed antibody-drug conjugate |
Jan. 2020 |
June 2019 |
Combined with bendamustine and rituximab EU: For patients not candidates for stem cell transplant US: After two or more prior therapies |
Sources:
AplusA DLBCL Syndicated Market Tracker 2020