Mosunetuzumab for Aggressive Lymphoma: 'Not a Home Run'

Ann S. LaCasce, MD, MMSc


January 02, 2020

This transcript has been edited for clarity.

I'm Ann LaCasce, one of the lymphoma specialists at Dana-Farber Cancer Institute in Boston. I'd like to talk about the mosunetuzumab study presented recently during the American Society of Hematology Annual Meeting plenary session.[1] Selection for a plenary presentation reflects that this is one of the top reviewed abstracts in lymphoma at the meeting. It was eagerly awaited by all of us.

There has been a lot of excitement about this bispecific antibody to CD20 and CD3, particularly in the patient population that has progressed after a chimeric antigen receptor (CAR) T-cell therapy. I think this is one of our biggest unmet needs in diffuse large B-cell lymphoma. And in terms of safety, this drug is well tolerated; there is not a lot of neurotoxicity, and the cytokine release syndrome data look quite good.

But I have to say that thus far it does not really look to be a home run in this setting. The number of patients presented who had had prior CAR T-cell therapy was relatively small, at about 30. And the responses in the aggressive lymphoma patients were honestly a little bit disappointing: a 37% objective response rate and a 19% complete remission rate.

The complete remission rates and durability look—at least preliminarily—like we have more work to do. Perhaps in the future this drug could be combined with other agents in this setting. Or maybe this is a drug with good activity in lines of therapy prior to CAR T-cell therapy, and perhaps even in combination, given that it targets CD20 and not CD19.

Everyone was eagerly awaiting the data, and while it was an interesting presentation, the bottom line is that we have more work to do.

Ann LaCasce, MD, MMSc, is an associate professor of medicine and a lymphoma specialist at Dana-Farber Cancer Institute, where she also directs the fellowship program in hematology/oncology. She serves on the Alliance Lymphoma Committee, the National Cancer Comprehensive Lymphoma Guidelines Panel, and the Lymphoma Research Foundation's Scientific Advisory Committee.

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