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Duvelisib + nivolumab is a combination therapy being evaluated for the treatment of aggressive B-cell malignancies, specifically Richter syndrome and transformed follicular lymphoma. Duvelisib is an oral dual inhibitor of the delta and gamma isoforms of phosphoinositide-3-kinase (PI3K), which are critical for the growth and survival of malignant B cells and the modulation of the tumor microenvironment. Nivolumab is a humanized monoclonal antibody that inhibits the programmed cell death protein 1 (PD-1) receptor on T cells, thereby preventing the interaction with its ligands (PD-L1 and PD-L2) and restoring the immune system's ability to recognize and eliminate cancer cells. The combination aims to provide a synergistic effect by simultaneously targeting intrinsic B-cell signaling pathways and extrinsic immune evasion mechanisms.
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