Emerging Agents for Follicular Lymphoma

OncLive has a brief interview with Dr. John Leonard of Weill Cornell, in which the good doctor discusses some of the more recent and upcoming treatments for Follicular Lymphoma.

As I said, this is a brief interview, but it's got some good stuff in it.

He mentions Ibrutinib and Idelalisib, but a lot of his focus is on Lenalidomide (also known as Revlimid), probably because he was lead author on an article from the Journal of Clinical Oncology from November, which I somehow missed.

(Before I get to that article, let me just swoon for a moment over some of Dr. Leonard's co-authors, which include Dr. Bruce Cheson, Dr. Myron Czuczma, and Dr. Nancy L. Bartlett, all Lymphoma Rock Stars. It's enough to make a cancer nerd's heart go all aflutter.)

The JOC article, called "Randomized Trial of Lenalidomide Alone Versus Lenalidomide Plus Rituximab in Patients With Recurrent Follicular Lymphoma: CALGB 50401 (Alliance)," described a study of 91 patients. Half of them received Lenalidomide, and half received Lenalidomide + Rituxan (also known as R-Squared). Those who had only Lenalidomide had a response rate of 53%, with 20% achieving a Complete Response, while the R-Squared patients had response rate of 76%, with 39% achieving a Complete Response. Also, the Lenalidomide patients had a 22% failure rate, meaning that many had to drop out of the treatment because of adverse events. the R-Squared patients also had a better median time to progression (how long it took for the FL to get worse) -- 2 years for R-Squared vs. 1.1 years for Lenalidomide. Clearly, adding Rituxan changes things for the better.

He also mentions the AUGMENT trial, which looks at R-Squared vs. straight Rituxan, which should give another perspective on how well that combination works.

Dr. Leonard also mentions Venetoclax a couple of times. I have heard of this, but haven't seen too much about it as it is used for Follicular Lymphoma. (I know it has been used effectively on Chronic Lymphocytic Leukemia, like so many other cool treatments.) Venetoclax is another pathway treatment, cutting off a process that a cancer cell needs to survive. In this case, Venetoclax targets bcl-2, a protein that keeps the cell alive. By shutting off bcl-2, Venetoclax basically gives the cell permission to die.

Venetoclax is in clinical trials for Follicular Lymphoma. From what I have read, it is pretty powerful stuff -- powerful enough that it needs to be very carefully monitored.(A patient died from tumor lysis after being on Venetoclax. This means that the contents of the dying cells changed the patient's blood chemistry too quickly. Close monitoring or lower doses might be possible changes that keep that from happening.)

So, for me, I learned a couple of new things from the brief interview -- updated data for R-Squared, and more about how Venetoclax might be useful for us in the future. Pretty good for such a quick read.

venetoclax