Follicular Lymphoma Treatment Updates

If you've been reading the blog for awhile, you know I like to read and report on "state of the field" pieces that I find online. These are articles or videos from lymphoma experts that talk about where we are in terms of treatment, and maybe what we might expect in the near future.

I like to think I keep up with things pretty well, so these "where are we now?" pieces don't always give us anything new. But it is nice to see what gets lymphoma experts excited these days.

Here are a couple of them for you:

First, "Deep Data Dive Needed for Upfront Treatment Selection in iNHL." This was published last week on OncLive, and features a review of a presentation from Dr. Sonali Smith from the University of Chicago. The article is set up as a series questions about changes in the way indolent Non Hodgkin's Lymphoma is treated, based on recent clinical trial results. (This isn't strictly about Follicular Lymphoma, then, but FL is the most common indolent, slow-growing lymphoma, so a lot of it applies to FL).

The questions:
Can the “Chemo-Free” R² Regimen replace Chemoimmunotherapy?
Can Obinutuzumab replace Rituximab?
Should patients receive Maintenance therapy? 

The answers?
Well, if you were expecting a simple "Yes/No" answer, you haven't been reading about Follicular Lymphoma too much. There are a lot of "maybe" or "it depends" answers here. R-squared is an alternative to traditional chemo, but not in all cases. It is effective, and does have different side effects than chemo, but not necessarily fewer of them. Obinutuzumab is a good alternative for some patients, but Rituxan still works fine, and there's no difference in Overall Survival between them. And maintenance? I'm not even going to bother answering that one, except to say that, yes, sometimes it's a good thing.

So that's the state of were we are -- lots of questions that still need answers.

Or do they?

You can look at this as being a frustrating lack of definite answers, which is understandable.
Or you can look at it as our having lots of choices. To me, I take comfort in knowing that there are lots of options for me. Rituxan has a way of not working after a while if patients get too much of it. there's some suggestion that Obinutuzumab might work for those patients.

See? Options are good.

The other one to share is called "Follicular Lymphoma: Recent and Emerging Therapies, Treatment Strategies, and Remaining Unmet Needs," published a few months ago in The Oncologist. (Thanks to reader Christine for sharing the link with me.)

Unlike the first one, this article is meant to be comprehensive, giving generalist oncologist (not lymphoma specialists) an overview of Follicular Lymphoma: statistics about who gets it, how it is staged and risk-stratified, and how patients at various places in their FL experience can be treated (newly diagnosed with no symptoms, newly diagnosed with some symptoms, previously treated, etc.).

It also has a pretty good list of treatments that currently in trials -- pathway inhibitors, bispecifics, antibody-drug conjugates. You can read about some of them here and here, if you want a little more detail. If that first article is hopeful because it suggests we have lots of options right now, then this one is super-hopeful because it shows that there are lots of options that might be available to us in the near future.

Of course, it also describes some of the challenges that we face, too -- effective treatments that also mess with our Quality of Life, especially if we need to take multiple treatments over many years (which is the case for a lot of us); we're still unsure of the best sequence for treatments -- which comes first, and after that stops working, what to try next, etc. And difficulty in figuring out which patients are likely to transform, or to need treatment within 2 years after their first treatment (EFS24).

So there are still lots of challenges out there, but lots to be happy about right now, and lots to be hopeful about in the future. I look back at the state of the field in 2008, and I'm amazed at how far we've come since then (there have been 12 treatments for Follicular Lymphoma approved by the FDA in the 12 years since I was diagnosed. How cool is that?)

Stay educated, everyone. But mostly, stay hopeful.