Refining Therapeutic Strategies for FL

OncLive has another Peer Exchange video series on Follicular Lymphoma. The Peer Exchange series is always excellent -- it brings together experts in an area to discuss up-to-the-minute research.

This series is called "Refining Therapeutic Strategies for Follicular Lymphoma," and it features Dr. Ian Flinn, Dr. Sarah Cannon, Dr. Peter Martin, Dr. Loretta J. Nastoupil, Dr. Grzegorz Nowakowski, and Dr. Anas Younes. It highlights recent research in FL, especially research from last month's ASH conference.

The Peer Exchanges usually involve a series of videos, with a new one published every few days. In this series, the first video is called "Follicular Lymphoma: Outcomes After Immunochemotherapy," and it was posted last Friday. Dr. Nowakowski makes an interesting and hopeful point: As we know, about 20% of FL patients who have had immunochemotherapy (like R-CHOP or R-Bendamustine) will relapse within two years, and these patients have a less favorable outcome, statistically, than the rest. However (this is the hopeful part), for the other 80%, Nowakowski says, "if you do not relapse within the first 2 years after chemoimmunotherapy in follicular lymphoma, your life expectancy is just like anybody else in that population." That's nice to hear.

(Again, this is based on statistics, and describes the whole group of us. Each of us will respond differently, whether we're in the 20% or the 80%, good or bad. He also points out how very heterogeneous the disease is -- we all have FL, but there are lots of different things happening in our bodies as a result.)

Dr. Nowakowski also had hopeful things to say about transformation (something we all fear). He says patients who have an anthracycline-containing treatment (such a CHOP) after transformation often "do quite well." (I like this doctor. He gives me lots of good news, but he seems realistic, too.)

Dr. Martin discusses the use of prognostic tools like the different FLIPI scores. They were not meant to be predictors of patient outcomes, and they don't always match up with how a patient's disease carries on. That's a good reminder for us all -- statistics don't say anything about us as individual patients.

The second video in the series is called "Upfront Therapy Strategies in Follicular Lymphoma." Dr. Nastoupil discusses some of the factors that go into deciding which treatment to use at first, and when to treat. Again, the message is that we're all different, and there's no single right answer. She tries to consider many factors in making those decisions (and she believes other oncologists do the same thing), including how well a patient will be able to tolerate the side effects of particular treatments. Knowing the patient seems like a very important part of making the decision. (She is also sure to discuss clinical trials as options, something we should all think about.) Dr. Younes agrees with the idea that we have a number of options, and the needs of the individual patient need to be considered.

The third video in the series (published today) continues the conversation, and is called "Challenging the Role of Maintenance Therapy in FL." Maintenance therapy is still a controversial topic among FL experts, with lots of discussion on whether it is necessary, and for how long, and which treatment should be involved. A recent presentation at ASH, says Dr. Martin, confirms that maintenance (Rituxan for two years after immunochemotherapy) improves Progression Free Survival (the time until patients' disease gets worse), but not Overall Survival (it doesn't help patients live longer). The panelists discuss the results of several long-term studies of maintenance, and don't find any easy answers about who should have it and when. Dr. Younes points out, again, that it is an individual patient's choice.

And that seems to be the theme here. Follicular Lymphoma is, unfortunately, the "No Easy Answer Cancer." We have lots of research that tells us important stuff, and lots that seems to tell us the opposite.

But I think that's OK. In the end, we have a lot of choices, and most of them are good choices. the important thing is, as patients, we need to stay informed about those choices, and continue to communicate with our doctors about what is important to us. Does PFS matter -- do we want to go as long as possible between treatments? Does Quality of Life matter -- do we want the fewest and least harsh side effects so we can live relatively normal lives? Does being aggressive matter -- do we want to feel like we are doing everything we can to attack the cancer?

Those questions matter, and a good oncologist will want to hear the answers, and help guide us to treatment decisions that make the most sense for what we need.

This Peer Exchange series will probably continue for at least a week. If you want to hear more from the panel, click one of the links every few days and see which videos they have added.

Lots of good stuff here that should bring us lots of hope.