What is Polatuzumab (Polivy, anti-CD79b monoclonal antibody)?

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Last updated: April 24, 2025 • View editorial policy

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From the Guidelines

Polatuzumab vedotin, in combination with rituximab-cyclophosphamide-edoxorubicine-prednisone (Pola-R-CHP), has demonstrated improved progression-free survival (PFS) versus R-CHOP in patients without HIV, but its use in HIV-associated diffuse large B-cell lymphoma (DLBCL) is not well established due to lacking data 1.

Current Treatment Landscape

The current standard treatment for HIV-associated DLBCL involves the use of rituximab in combination with chemotherapy, with regimens such as R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) being commonly used 1. Other regimens like DA-R-EPOCH (dose-adjusted rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) have shown promise, particularly in certain patient populations, but the choice of regimen often depends on various factors including the patient's overall health, specific disease characteristics, and potential comorbidities.

Considerations for Polatuzumab Use

Given the lack of direct evidence supporting the use of polatuzumab in the context of HIV-associated DLBCL, its application in this setting would be considered off-label. However, for patients who have failed or are intolerant to standard therapies, polatuzumab vedotin, as part of a combination regimen like Pola-R-CHP, might be considered as a potential treatment option, taking into account the individual patient's risk factors, disease status, and the potential benefits and risks associated with the treatment.

Key Points to Consider

  • The decision to use polatuzumab in HIV-associated DLBCL should be made on a case-by-case basis, considering the latest clinical evidence and guidelines.
  • Patients should be closely monitored for potential side effects and toxicities associated with polatuzumab vedotin, including peripheral neuropathy and infusion-related reactions.
  • The role of CNS prophylaxis in patients with DLBCL, including those with HIV, should be considered based on individual risk factors and current clinical guidelines 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Overview of Polatuzumab

  • Polatuzumab vedotin is an antibody-drug conjugate that targets CD79b, a protein expressed on the surface of B cells, delivering a potent antimitotic agent (monomethyl auristatin E) to B cells 2, 3.
  • It has been studied in combination with bendamustine and rituximab (BR) for the treatment of relapsed or refractory diffuse large B-cell lymphoma (DLBCL) 2, 4, 5.

Efficacy of Polatuzumab Vedotin

  • The complete response rate (CRR) of polatuzumab vedotin in combination with BR was 34.3% at the end of treatment, with an overall response rate of 42.9% 2.
  • A systematic review and meta-analysis of eight studies with 398 patients found a significant overall response rate of 52.6%, complete response of 34.3%, and partial response of 15.5% 4.
  • Polatuzumab vedotin in combination with BR has been shown to improve progression-free survival and overall survival in patients with relapsed or refractory DLBCL 5, 6.

Safety of Polatuzumab Vedotin

  • The most common adverse events associated with polatuzumab vedotin in combination with BR are hematologic toxicities, including neutropenia, thrombocytopenia, anemia, and febrile neutropenia 2, 4, 5.
  • Peripheral neuropathy is also a common adverse event, although grade 3 or higher events are rare 2, 5.

Ongoing Research and Approvals

  • Polatuzumab vedotin is being studied in a randomized trial in the frontline setting in combination with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) 3.
  • It has been approved in the US and EU for use in patients with relapsed or refractory DLBCL who are ineligible for transplant 5, 6.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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