Current Treatment Challenges
Navigating Treatment Approaches Can Be Challenging

Although the treatment of PCNSL has evolved during the past few decades, no consensus has been reached on the optimal standard of care in R/R PCNSL.1

Considerations for R/R PCNSL treatments include2:

  • Prior therapies
  • Quality of response to prior therapies
  • Duration of remission

What Are the Challenges With R/R PCNSL Treatment Options?

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Many current treatments in R/R PCNSL can cause significant toxicity3-5

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Elderly patients often have comorbid conditions and treatment can be difficult to tolerate, resulting in poor prognosis5-8

Patients may be unable to tolerate further intensive therapy due to multiple factors2,6,8

  • Debilitating symptoms, such as cognitive impairment and paralysis
  • Advanced age
  • Renal insufficiency
  • Impaired performance status
  • Poor physiological fitness
  • Other comorbidities

The primary recommendation of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for R/R PCNSL is clinical trial participation.9*

There are many options, but...

RR/PCNSL
  • No FDA-approved treatment options2,6
  • No standard of care2,6
  • No preferred regimen, per NCCN Guidelines®6,9

*National Comprehensive Cancer Network® (NCCN®) believes that the best management of any patient with cancer is in a clinical trial.9

NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.

What are the obstacles to advancement in 
R/R PCNSL treatment?

Future Outlook

†Also a type of chemotherapy.

Not all drugs within the presented classes are used in the treatment of R/R PCNSL.

ASCT=autologous stem cell transplant; BTKi=Bruton tyrosine kinase inhibitor; FDA=Food and Drug Administration; IMiD=immunomodulatory drug; mAbs=monoclonal antibodies; R/R PCNSL=relapsing or refractory primary central nervous system lymphoma.

References: 1. Mendez JS, Grommes C. Treatment of primary central nervous system lymphoma: from chemotherapy to small molecules. Am Soc Clin Oncol Educ Book. 2018;38:604-615. doi:10.1200/EDBK_200829 2. Ambady P, Doolittle ND, Fox CP. Relapsed and refractory primary CNS lymphoma: treatment approaches in routine practice. Ann Lymphoma. 2021;5:23. doi:10.21037/aol-21-20 3. Nagle SJ, Shah NN, Ganetsky A, et al. Long-term outcomes of rituximab, temozolomide and high dose methotrexate without consolidation therapy for lymphoma involving the CNS. Int J Hematol Oncol. 2017;6(4):113-121. doi:10.2217/ijh-2017-0020 4. Li Q, Ma J, Ma Y, Lin Z, Kang H, Chen B. Improvement of outcomes of an escalated high-dose methotrexate-based regimen for patients with newly diagnosed primary central nervous system lymphoma: a real-world cohort study. Cancer Manag Res. 2021;13:6115-6122. doi:10.2147/cmar.s322467 5. Liu Y, Yao Q, Zhang F. Diagnosis, prognosis and treatment of primary central nervous system lymphoma in the elderly population (review). Int J Oncol. 2021;58(3):371-387. doi.10.3389/fonc.2021.649789 6. Tao K, Wang X, Tian X. Relapsed primary central nervous system lymphoma: Current Advances. Front Oncol. 2021;11;649789. doi:10.3892/ijo.2021.5180 7. Schlegel U. Primary CNS lymphoma. Ther Adv Neurol Disord. 2009;2(2):93-104. doi:10.1177/1756285608101222 8. Kaulen LD, Baehring JM. Treatment options for recurrent primary CNS lymphoma. Curr Treat Options Oncol. 2022;23(11):1548-1565. doi:10.1007/s11864-022-01016-5 9. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Central Nervous System Cancers V.1.2023. © National Comprehensive Cancer Network, Inc. 2023. All rights reserved. Accessed September 14, 2023. To view the most recent and complete version of the guideline, go online to NCCN.org.