How will you use Pola-R-CHP in the frontline treatment of DLBCL?

Given the comparable toxicity profile and the lower rate of treatment failure, the number needed to treat (n=16) is low enough that this is very appropriate to be the new standard of care. Although overall survival was not different, fewer patients treated with the Pola-R-CHP regimen required subsequent treatment with radiation, transplant, and CAR-T.

PFS benefit of around 7% (HR-0.73) and perhaps beneficial in DLBCL with higher IPI. Not clear that everyone is going to benefit from CHP-Pola. Would pay closer attention to details of neuropathy even though they were reportedly similar.

Agree with @Dr. First Last that Pola-R-CHP represents a new standard of care for a subset of patients with newly diagnosed DLBCL. I am very comfortable recommending the regimen for patients who meet the inclusion criteria for POLARIX (IPI2+, up to age 80 with adequate performance status). Subset analysis, updated at ASH 2024, suggested that greater benefit is accrued in higher-risk patients (IPI3+, ABC phenotype, molecular high-grade disease), with an apparent post-hoc OS advantage in ABC patients. And it was previously reported that, within the "GCB" subset, dark-zone signature (a more molecularly aggressive subset) derived more benefit than light-zone signature disease. Toxicity does indeed seem very similar, and a cost-benefit analysis f...