Dr. John Leonard on Follicular Lymphoma

About three weeks ago, OncLive published two pieces on Follicular Lymphoma, both featuring Dr. John Leonard.

He's a good guy to feature -- a legitimate Lymphoma Rock Star, he's the Richard T Silver Distinguished Professor of Hematology and Medical Oncology at Cornell Weill. He knows the cutting edge as well as anyone.

In the first OncLive piece, "Novel Agents on Horizen for Follicular Lymphoma," Dr. Leonard discusses clincial trial results for a few different treatments. But before he gets into that, he says something very comforting:

"Most patients will not die from follicular lymphoma, and that's very reassuring. About 80% of patients will die with their follicular lymphoma and not of their follicular lymphoma."

“Most patients will not die from follicular lymphoma, and that's very reassuring. About 80% of patients will die with their follicular lymphoma and not of their follicular lymphoma - See more at: http://www.onclive.com/conference-coverage/hematology-2016/novel-agents-on-horizon-for-follicular-lymphoma#sthash.mwHedDcv.dpuf

Novel Agents on Horizon for Follicular Lymphoma"

Richard T. Silver Distinguished Professor of Hematology and Medical Oncology, NewYork-Presbyterian Weill Cornell Medical Center. - See more at: http://www.onclive.com/conference-coverage/hematology-2016/novel-agents-on-horizon-for-follicular-lymphoma#sthash.mwHedDcv.dpuf

Richard T. Silver Distinguished Professor of Hematology and Medical Oncology, NewYork-Presbyterian Weill Cornell Medical Center. - See more at: http://www.onclive.com/conference-coverage/hematology-2016/novel-agents-on-horizon-for-follicular-lymphoma#sthash.mwHedDcv.dpuf

Richard T. Silver Distinguished Professor of Hematology and Medical Oncology, NewYork-Presbyterian Weill Cornell Medical Center. - See more at: http://www.onclive.com/conference-coverage/hematology-2016/novel-agents-on-horizon-for-follicular-lymphoma#sthash.mwHedDcv.dpuf

Let that sink in for a second.

I'm not big on statistics. The times when cancer has made me saddest have been the times I got caught up in statistics. My policy now is to only pay attention to statistics that make me happy. And that one makes me happy. It should make all of us happy.

As for the studies he cites:

• There's Obinutuzumab (also known as Gazyva), an "next-generation" ant-CD20 monoclonal antibody, approved by the FDA in combination with Bendamustine, for patients who have previously had Rituxan. The study that led to the approval was the GADOLIN study, which found that the combination reduced the risk of disease progression by 52%, compared to Bendamustine alone.
• R-Squared: In another study, Revlimid + Rituxin (R-squared) had a 75% response rate. Revlimid alone had a 44% response rate.
• In another one, Idelalisib showed a 56% response rate.

None of these studies are new (I think I've discussed all of them here at some point), but together, they give a good sense of why that 80% of patients will do OK.

But what about the other 20%? Research from the last year or so has shown that this is a tougher population to work with, only because we know less about them. But there are already some trials with new treatments that are trying to address this group of patients.

• Nicolumab, is in a phase 2 study.
• Pembrolizumab (plus Rituxan) is also in a phase 2 study,
• And in a small study of 30 patients, Pizilibumab had an overall response rate of 66% for patients who relapsed.

So while that 20% might be worrisome, there are some studies out there that are focused on it. As Dr. Leonard says, figuring out what makes this group different from others needs to be a priority, so more targeted treatments can be developed for their needs.

Dr. Leonard also thinks we need to ask bigger questions about the goals for patients -- are we going for a cure, or trreating FL like a chronic disease? -- and thinking about how we measure success, and how we consider quality of life for patients who may need treatment for a very long time.

All very interesting information.

And as I said, OncLive published a second piece a couple of days later, also featuring Dr. Leonard. This one is called "Dr. John Leonard on Treatment Options forRelapsed Follicular Lymphoma," and it has a short video in which Dr. Leonard discusses some of the options for patients who have already had treatment, particularly R-Squared. It doesn't get into much detail, but again, it's nice to hear a big list of our options.

Dr. John Leonard on Treatment Options for Relapsed Follicular Lymphoma - See more at: http://www.onclive.com/conference-coverage/hematology-2016/dr-john-leonard-on-treatment-options-for-relapsed-follicular-lymphoma#sthash.jjkVXQYO.dpuf

(Sorry for the strange change in font at the end. Not sure why it's doing that, and I can't seem to fix it....)