Options for Newly-Diagnosed Follicular Lymphoma

Targeted Oncology has a nice piece on a presentation by Dr. John Leonard at the CFS (Chemotherapy Foundation Symposium) in New York this week. He spoke about the options for newly diagnosed Follicular Lymphoma patients, and the recent research that helps us understand them.

Basically, newly-diagnosed FL patients fall into one of three groups:
Localized Disease
Advanced Stage Disease with Low Tumor Burden
Advanced Disease with Symptoms

Each group has different choices for treatment.

Limited Stage or Localized disease is usually stage 1 or 2. About 70% of patients will not need treatment for 10 or 15 years, so watch-and-wait or radiation is appropriate, rather than chemo. Recent research shows that adding chemo or chemo + maintenance to patients in this group increased the time between treatments, compared to patients getting radiation, but all three approaches had the same Overall Survival.

For patients with advanced stage (3 or 4) FL, but with no symptoms, there are other options. (This is the group I was in when I was diagnosed.) Options for this group also include watching-and-waiting, but, according to Dr. Leonard, Rituxan is also an option, and can last in longer times between treatments.  Dr. Leonard cites research that shows that just 4 doses of Rituxan gave a median Progression Free Survival of just under 2 years, with 15% of the group progression free at 7 years. (I watched and waited for 2 full years, and then had straight Rituxan -- I haven't needed treatment in almost 10 years.)

The there's the third group -- they are diagnosed with advanced disease, with symptoms like large tumors or aggressive disease. The standard first treatment is either Bendamustine + Rituxan or R-CHOP. The B-R tends to have fewer side effects with the same effectiveness. Other options include Obinutuzumab instead of Rituxan, or R-Squared (Rituxan + Revlimid). Again, Dr. Leonard cites recent research that shows how well these treatments work for this group.

Dr. Leonard also pointed out that there are a whole lot of questions that still need to be answered (like whether or not we'll ever have something that's more effective than watching and waiting but with few side effects so it doesn't affect Quality of Life.

There are more choices than just these, of course -- and plenty of clinical trials for patients in all three groups. As always when I read about treatments, I feel good knowing we have some decent options right now, and there are more coming in the future.