Researchers from MD Anderson Cancer Center just published "Factors Influencing Outcome in Advanced Stage, Low-Grade Follicular Lymphoma Treated at MD Anderson Cancer Center in the Rituximab Era" in Annals of Oncology.
The title was a little misleading to me -- the focus isn't on a whole lot of factors other than certain treatments that patients received, although their conclusions do get into some wider issues.
Still, what they have to say is definitely worth taking a look at.
The researchers looked at patients from their facility only -- 356 of them who received certain treatments from 2004-2014 (a few years after Rituxan was introduced). As they point out (and as we all know), there really isn't an accepted first treatment for FL patients -- lots of disagreement about what to do first. So they hoped to look back at patients and see what treatment they received and how well they did, and figure out what seemed to work best. Thet used 3 year Progression-Free Survival as their measurement (that is, the disease didn't get any worse for at least 3 years).
Here is what they found:
For patients receiving R-CHOP, the 3 year PFS was 60%.
For patients receiving R-CHOP with Rituxan Maintenance, the 3 year PFS was 72%.
For patients receiving Bendamustine + R, the 3 year PFS was 63%.
For patients receiving Bendamustine + R with Rituxan Maintenance, the 3 year PFS was 97%.
For patients receiving Lenalidomide + Rituxan [R-squared], the 3 year PFS was 87%
While Bendamustine + R had the best number, the researchers also point out that R-squared had a very high number AND fewer "high risk features" than chemotherapy (which includes Bendamustine). We're seeing some very positive stuff about R-squared in the last few months, and this adds to it.
The researchers also looked at Overall Survival, and found that patients who had disease progression within two years after treatment had a lower OS (something we have been hearing more of in the last few months, too), and patients who transform have a lower OS (which we already knew).
Personally, I find the B + R + Maintenance number pretty impressive, but that R-squared statistic is also something that we can be happy about. The general trend seems to be moving away from chemotherapies, even one like Bendamustine that had fewer and less aggressive side effects than CHOP. R-squared, like other targeted therapies, are really what Follicular Lymphoma's future looks like.
As always, we need to think about all of this carefully -- it's a relatively small study, of patients in just one center, so other factors can also play a part in the results. But if we think about it all as part of some larger trends, this is all something to be happy about.