The waiting room at Vancouver General Hospital’s oncology department is both familiar and foreign to me. I’ve spent hours here over the past three months, listening to patients with diffuse large B-cell lymphoma (DLBCL) share their stories of treatment cycles, remissions, and devastating relapses. Today, the mood feels different – there’s a current of cautious optimism running through conversations.
“It’s not a miracle cure,” Dr. Amina Patel tells me, tucking a strand of hair behind her ear as we sit in her cluttered office. “But for patients who’ve exhausted conventional options, it represents something we’ve been desperate for – a new mechanism of action that’s showing remarkable response rates.”
She’s referring to glofitamab, a bispecific antibody that Health Canada has just approved for use in combination with chemotherapy for adult patients with relapsed or refractory DLBCL. The approval marks a significant milestone for Canadian patients facing one of the most common and aggressive forms of non-Hodgkin lymphoma.
“When your cancer returns after multiple treatments, your options historically became very limited,” explains Marie Fournier, a 62-year-old former teacher from Richmond who experienced three relapses before entering a clinical trial. “Each time it came back, I felt like I was running out of road.”
DLBCL affects approximately 2,900 Canadians each year, according to Lymphoma Canada. While many patients respond to initial treatment, about 40% relapse or develop resistance to standard therapies. Until recently, those patients faced increasingly difficult choices with diminishing chances of long-term remission.
Glofitamab works differently than conventional treatments. It’s a T-cell engaging bispecific antibody that simultaneously binds to CD20 proteins on B-cells and CD3 proteins on T-cells, effectively creating a bridge that helps the immune system identify and attack cancer cells. The mechanism represents a fundamental shift in how we approach these difficult-to-treat blood cancers.
Health Canada’s approval was based on results from the phase I/II NP30179 study, which showed that 51.6% of patients with heavily pretreated relapsed or refractory DLBCL achieved a complete response – meaning no detectable cancer after treatment. The overall response rate was 61.5%, with many responses proving durable beyond 12 months.
“What makes these numbers remarkable is the context,” Dr. Patel emphasizes. “These patients had a median of three prior lines of therapy. Many had failed stem cell transplants or CAR-T cell therapy. These are patients who previously had very limited options.”
The approval comes with certain considerations. The most serious side effect is cytokine release syndrome (CRS), an inflammatory response that occurs when large numbers of immune cells are rapidly activated. To mitigate this risk, patients receive a stepped-up dosing schedule and pretreatment with obinutuzumab, another antibody that helps prepare the body for treatment.
Walking through the Lynn Valley trails near my home the day after interviewing Dr. Patel, I find myself thinking about what this approval means beyond the clinical data. Cancer treatments are ultimately about people, not percentages.
I recall my conversation with Daniel Crowfoot, a lymphoma patient advocate from the Squamish Nation who has been tracking developments in DLBCL treatments since losing his brother to the disease in 2018.
“In our communities, cancer diagnoses often come later, when the disease is more advanced,” Crowfoot told me. “Having more effective options for relapsed disease means more of our people might get second chances.”
The financial implications remain complex. While Health Canada’s approval makes the treatment officially available, provincial coverage decisions will ultimately determine accessibility for most patients. The pan-Canadian Oncology Drug Review process, which makes recommendations about public drug plan coverage, is expected to begin evaluation soon.
“The approval is just the first step,” says Dr. Kerry Mansell, a pharmacoeconomist at the University of British Columbia who studies cancer drug funding. “Now comes the challenging work of determining the cost-effectiveness threshold and negotiating pricing that balances innovation with sustainability of our healthcare system.”
For hematologist Dr. Julia Chen at BC Cancer, the approval represents a welcome addition to a rapidly evolving treatment landscape. “We’re seeing remarkable innovations in lymphoma therapy right now,” she explains. “Bispecific antibodies like glofitamab, CAR-T cell therapies, antibody-drug conjugates – we have more sophisticated tools than ever before.”
But she cautions against seeing any single approach as the ultimate solution. “Each patient’s disease is unique, and having multiple options with different mechanisms allows us to personalize treatment strategies. The goal is to turn DLBCL into a chronic, manageable condition if we can’t cure it outright.”
For patients like Marie Fournier, who has now been in remission for 14 months following her trial participation, the scientific advances translate into precious time. “I was able to see my grandson’s first birthday,” she says, her eyes brightening. “Every month feels like a gift I wasn’t sure I’d receive.”
As Canada’s healthcare system works to integrate this new therapy into clinical practice, questions of equity and access remain. Rural patients, those in territories with limited specialist care, and individuals from marginalized communities often face additional barriers to accessing novel treatments.
The path from regulatory approval to clinical implementation is rarely straightforward. But for Canadians facing relapsed or refractory DLBCL, glofitamab’s approval represents something powerful – the possibility of response when other options have failed.
As I leave Dr. Patel’s office, she shares one final thought: “Progress in cancer treatment rarely comes from single breakthroughs. It’s incremental gains, new mechanisms, and deeper understanding that gradually shifts outcomes. This approval is one important piece of that larger puzzle.”
For the patients I’ve met during this reporting – those in waiting rooms hoping for new options and those who may never need them – each piece of that puzzle represents something profound: the chance for more time, more life, more possibility.
