Wednesday, June 3, 2015

ASCO: Choosing Treatments for Follicular Lymphoma

Another quick ASCO review:

AJMC has a report of a session from ASCO called "Incorporating Novel Agents into Lymphoma Therapy: Value in Everyday Practice." The session included several doctors who discussed their experience with some newer treatments.

Discussing Follicular Lymphoma was Dr. Gilles Salles of Lyon, France. As reported in the AJMC article, Dr. Salles had a few things to say about some newer FL tratments:

  • Attempts to improve on Rituxan, by developing other monoclonal antibodies that target CD20, have been disappointing. Ofatumumab isn't as effective, and Obinutuzumab performs about as well (but not better).
  • Some other monoclonal antibodies are in the works. They target different proteins that Rituxan targets: CD22, CD37, CD74, and CD80. We're still waiting to see if they improve in Rituxan. [This is just a reminder to us all about how amazing Rituxan is, and how much it has changed things for FL patients.]
  • Lenalidomide (also known as Revlimid) has been useful in helping the immune system recognize that FL cells don't belong there. [I hope to write more on Revlimid at ASCO very soon.]
  • Anti-PD1 treatments are still getting the cancer research community excited. One of them, Pidilizumab, when combined with Rituxan, resulted in more than 50% of Follicular Lymphoma patients having a response.
  • Pathway targeting treatments are also very promising. Idilalisib showed promise in a phase 2 study being presented at ASCO, with a 56% response rate.
Dr. Salles cautioned against using some of these newer agents as first-line treatments for patients with low tumor burden. While they are more targeted than traditional chemotherapy, they still carry some side effects, and at this point, they cost a lot. He thinks other, older treatments (like Rituxan, I assume) can keep things under control while helping maintain a good quality of life in the patient.
Incorporating Novel Agents into Lymphoma Therapy: Value in Everyday Practice.” - See more at: http://www.ajmc.com/conferences/ASCO2015/Choosing-Ideal-Lymphoma-Regimens-in-the-Clinic#sthash.ZRjsAFW1.dpuf
Incorporating Novel Agents into Lymphoma Therapy: Value in Everyday Practice - See more at: http://www.ajmc.com/conferences/ASCO2015/Choosing-Ideal-Lymphoma-Regimens-in-the-Clinic#sthash.ZRjsAFW1.dpuf
Incorporating Novel Agents into Lymphoma Therapy: Value in Everyday Practice - See more at: http://www.ajmc.com/conferences/ASCO2015/Choosing-Ideal-Lymphoma-Regimens-in-the-Clinic#sthash.ZRjsAFW1.dpuf


Interestingly, he mentioned Stem Cell Transplants as options for younger patients who relapse, while older patients might consider some non-chemo treatments.


It's a nice summary of where we are, from a well-known expert in Follicular Lymphoma.

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2 comments:

  1. AnonymousJune 6, 2015 at 9:21 AM

    Hi Bob,

    You mention that "Obinutuzumab performs about as well (but not better)."

    This article (http://www.medscape.com/viewarticle/845906) says that Obinutuzmab works in patients who are refractory to rituximab. It seems like another good 'arrow' later down the road.

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  2. LymphomaniacJune 8, 2015 at 7:36 AM

    Yes, you are correct. I was going by what the article said, a report of what Dr. Salles had to say: "A head-to-head study of rituximab vs obinutuzumab (GA101) showed no difference." I think it's definitely another arrow in the quiver, and I think it will be used more and more either in combination, or by itself when we have a better sense of which patients it might work on, based on genetic profiles. But I also think it's true that no one has been able to improve on Rituxan in a way that would make any of us forget about Rituxan any time soon....
    Bob

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