Atezolizumab Combo for Follicular Lymphoma

As I have said, now that ASH is over, I've been looking at the ASH follow-ups out there -- either commentaries on some of the FL research that was presented, or descriptions of some of the interesting research that I missed the first time around.

Here's another one that I missed -- a presentation on the combination of Atezolizumab (also known as Tecentriq), Obinutuzumab (also known as Gazyva), and Bendamustine (also known as Treanda).

Bendamustine has been well-known in the FL community for a while. It's a traditional chemotherapy that has been shown to be effective and well-tolerated. Obinutuzumab is a little newer. It's a monoclonal antibody that targets B cells (like Rituxan, which has been around much longer).

Atezolizumab is less well-known to people with FL, but it's better known to the wider cancer community. It was approved by the FDA in the last couple of years for certain types of kidney and lung cancer. Like Rituxan and Obinutuzumab, it is a monoclonal antibody. It works by targeting PD-L1, or Programmed Death Ligand 1. Just as Rituxan targets the CD20 protein on a cell's surface, Atezolizumab targets the PD-L1 protein. By blocking PD-L1, the immune system is able to send signals that the cancer cells are invaders and should be attacked.

According to the presentation at ASH, 42 FL patients were given the combination. 35 of those patients then had maintenance with Atezolizumab and Obinutuzumab. Most of the patients had not received treatment before.

The results were pretty good -- 85% Overall Response Rate, with 75% Complete and 10% partial. (The Response rates were calculated a few different ways; these numbers are the most conservative of them.)

There were, of course, side effects, with all 42 patients experience Adverse Effects of some kind (and over half of them experiencing grade 3 or 4, the highest AEs).

This combination  makes sense. There have been some attempts at using Atezolizumab on its own in Lymphoma, but they haven't been very successful. The three different treatments mean the cancer cells are being targeted in 3 different ways. An approach like that makes sense.

However, as we have seen in combination treatments, sometimes different treatments interact in ways that create problems that aren't there when they are used on their own. It seems like this combination has that potential. The lead researcher, Dr. Anas Younes, noted that long-term follow-up will be necessary to see if the risks of the combination is worth the results.

Dr. Younes describes the study in a video for OncLive. Definitely early, but something worth keeping an eye on.