Follicular Lymphoma: When to Treat?

OncLive has a great series called "Peer Exchange."  It's a series of videos on different cancer-related topics with a group of experts in the area. Their most recent one is called "Evolving Paradigms for B Cell Non-Hodgkin Lymphoma," and it starts off with a discussion of Follicular Lymphoma. The first video in the series is called "Follicular Lymphoma: Triggers to Initiate Therapy."

The series has some great oncologists, and the one who does most of the talking in this first video is Dr. Leo Gordon from Northwestern University and the Lurie Cancer Center in Chicago. He is asked to talk about what triggers therapy -- when do patients need to start treatment?

Interestingly, he starts by saying he still takes a watch-and-wait approach with most of his patients. (As many of you probably know, there's an ongoing debate about whether or not to watch and wait, or whether to just start with treatment like Rituxan right away. As a watch-and-waiter, I'm always interested in what experts have to say about this.

Dr. Gordon favors watching and waiting because, he says, there is no evidence that treating earlier leads to better survival rates. He makes the decision to begin treatment based first on B symptoms (things like night sweats or fevers) that suggest a more aggressive version of FL, or size of lymph nodes. However, he will consider smaller lymph nodes if they are pushing on something important. (This is what happened to me -- a fairly small but well-placed node near my hip was blocking things and making my leg swell up.)

Once the decision is made to treat, there are options, including Rituxan, R + chemo, and other, newer options (he mentions Lenalidomide, or R squared). As for chemo, CHOP has been historically the most popular, but Bendamustine seems to have become the new standard. Interestingly, he mentions that his main concern with Bendamustine is the lack of long-term follow-up, and he worries about long-term side effects, something that came out at ASH this year.

Dr. Gordon also suggests that targeted treatments may replace chemotherapy. He mentions a Swiss study (which doesn't sound familiar to me) that suggests that Rituxan and Rituxan Maintenance are bringing improved disease-free intervals in FL patients.

The "Peer Exchange" series doesn't publish all the videos at once, but instead puts out a new one every few days. As I'm writing this, they have posted the second and third videos in the series -- "Follicular Lymphoma: Consolidation and Maintenance" and "Sequencing Therapies for Follicular Lymphoma." You can find thumbnails for them underneath the main video. There is also a transcription for each video.

I'll look at the next videos in the series soon. I'm always interested in sequencing therapies -- figuring out which treatment to try first, but then which to try second and third, if necessary. (I always like to plan ahead.)

So more on this soon, though I also encourage you to watch them on your, too.

prolonged disease-free intervals in patients getting Rituxan alone - See more at: http://www.onclive.com/peer-exchange/nhl-treatment-paradigms/follicular-lymphoma-triggers-to-initiate-therapy#sthash.Z6G3r2WD.dpuf