When working on a new or existing brand within the DLBCL market it's important to have up to date patient data. This is the third post in our latest series on DLBCL that shares insights from the AplusA syndicated DLBCL tracker.
DLBCL variants
DLBCL consists of more than a dozen different subtypes that are pathologically and clinically diverse*. Hem/oncs reported that approximately 45% of EU5 and US R/R patients had germinal center B-cell (GCB) and 35% had non-germinal center B-cell (non-GCB) subtypes. Physicians had not classified and therefore did not know the subtype of 15% to 20% of their patients, depending upon country.
Approximately 15% of R/R DLBCL patients had been diagnosed each with BCL-6, BCL-2, and MYC rearrangements. The US had a noticeably lower percentage of patients with BCL-2 and a higher percentage with MYC rearrangements. SCT-eligible patients actually had a higher percentage of genetic defects than ineligible patients.
Roughly 5% of all R/R patients had high-grade DLBCL with expression of both MYC and BCL2 or BCL-6. The standard of care has not been established for these patients. Here, new therapies may provide a large role.
Based upon products and patients of interest to you, AplusA can customize tracker information to report on additional biomarkers (e.g., CD30, ALK), further sub-types, and underlying conditions (e.g., HIV, EBV, spread into the CNS).
First-Line DLBCL patient characteristics
EU5 hem/oncs reported that on average 30% of their DLBCL patients had been diagnosed within the past year. Germany was low at 20%, Italy was high at 45%, and the US rate was 40%.
At the time of diagnosis, slightly less than 2/3 of US DLBCL patients had stage III or IV disease. Notably more EU5 patients were diagnosed with late-stage disease. The UK had the most late-stage patients. Across countries, there was almost a 10 percentage-point difference in early stage diagnosis between SCT-eligible and SCT-ineligible patients.
Relapsed/ refactory DLBCL patient profile
About half of second-line patients were SCT-eligible and half were ineligible. Hem/oncs based ineligibility largely on patient age and comorbidities, but sometimes for other reasons including ECOG status and patient desire. Later-line eligibility was similar across EU5 countries but much higher in the US.
10% of EU5 and almost 15% of US R/R DLBCL patients were refractory with no response to first-line therapy. As expected, SCT-ineligible patients were more refractory. Of all R/R patients 40% had progressed to second-line more than 12 months after initial therapy. AplusA’s market tracker provides specific relapse times by regimen by country as input, for example, to product forecasts.
The median and mean ages of R/R DLBCL patients were approximately 65 years in EU5 countries and 62 years in the US. SCT-eligible patients were roughly 5 years younger than patients overall. An interesting difference was that the time since diagnosis was much lower for SCT- eligible than ineligible patients in the EU5 and much higher in the US.
For further insights on R/R DLBCL patients, as well as a market overview, treatment performance, and social media intelligence findings, download the full eBook for free here:
Sources:
AplusA Syndicated DLBCL Study
“NCCN Clinical Practice Guidelines in Oncology, B-Cell Lymphomas;”
National Comprehensive Cancer Network; Version 5.2019; September 23, 2019