Options for Follicular Lymphoma

MedPageToday posted a nice piece a few days ago called "Expanding Options for Follicular Lymphoma Patients in Relapse: Studies of the Microenvironment and Immune System Spark Enthusiasm." MedPageToday is geared toward health care professionals, and this article isn't the type that reports on something new. Instead, it gives a nice summary of some of the developments in treatment options for Follicular Lymphoma patients.

And as much as love reading and writing about exciting stuff in the clinical pipeline, it's also really nice to read a basic article that describes what is available to us at the moment. It's great to see all of that good stuff in one place.

The article open with some information about Rituxan, and the recent research that shows that retreating with Rituxan at the first relapse is as effective as treating with chemo + Rituxan, or Rituxan Maintenance. It also mentions the great success that "R-Squared" (Rituxan + Revlimid) has shown in Follicular Lymphoma.


And then we get to the "expanding options" from the title:

Like Idelalisib (Zydelig), the PI3 Kinase Inhibitor. Over half of FL patients in a phase II trial had a response to Idelalisib, which prompted the FDA to approve its use for relapsed FL (again this is old news).  Interestingly, one expert says that most research on Idelalisib has focused on its effects on B cells, but he thinks there is an effect on T cells (which would help the body fight the cancer cells on its own). I look forward to seeing that research some day.

That same expert (Dr. Stephen Ansell from the Mayo Clinic) points to the disappointing results from Ibrutinib (Imbruvica), another inhibitor (this one targeting Bruton's Tyrosine Kinase, or BTK). Dr. Ansell hasn't given up hope yet, though, and he thinks Ibrutinib might work for Follicular Lymphoma by combining it with another "checkpoint" treatment (that is, not one that targets the cancer cells directly, but one that stops certain processes that the cancer cells need in order to function).

And then there are the potential treatments that will help the immune system fight off cancer on its own -- the awesome Immunotherapy treatments.

One big challenge with all of this: we might have, as the article puts it, "drugs in search of patients." In other words, we might have a bunch of treatments that seem to work, but no idea which FL patients they will work on, exactly.

So the next step is finding biomarkers -- some kind of genetic or cellular or other mark that we can identify on an individual patient, and then match up a treatment that works with that biomarker.

The other big challenge: trying to balance effectiveness of a treatment with quality of life, which has become increasingly more important. A treatment might have a high chance of working, or of working for a long time, but a patient might rather opt for a less aggressive treatment with lower chances of success, or that won't work as long, if it means fewer side effects. That's certainly an important consideration for me.

So many exciting options, but so many questions that remain.

Overall, though, I'll take those unanswered questions as long as those great researchers keep trying to find answers.

Lots to be happy and hopeful about.